TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN CRITICALLY ILL PATIENTS - FEASIBILITY, SAFETY, AND IMPACT ON MANAGEMENT

Transesophageal echocardiography (TEE) is being used with increasing frequency in critically ill patients in whom transthoracic echocardiography (TTE) is often unsatisfactory in providing much needed information. We reviewed the indications, feasibility, and clinical impact of TEE in the intensive care setting at our institution. TEE was performed in 77 critically ill patients (age range 19 to 83 years) in whom TTE was inadequate or inconclusive. The general indications for performing a TEE were as follows: Hemodynamic instability (41%), possible endocarditis (34%), possible embolic source (21%), and possible aortic dissection (4%). In the subset of patients with hemodynamic instability, severe native mitral regurgitation was the most common underlying cause (25%), followed by hypovolemia after cardiac surgery (22%). TEE was feasible in all patients, 47% of whom were on mechanical ventilation. Two patients required stabilization before TEE, including a femoral artery-to-vein bypass in a patient with shock from a prosthetic valve obstruction. Complications, none of which proved to be fatal, occurred in two. Echocardiography led to a significant change in patient management in 46 of the 77 patients (60%), of which 48% was due solely to TEE. In these patients (n = 37), the TEE findings led to a change in medical management in 19% and to surgical intervention in 29%. While TTE remains the first line of diagnostic ultrasound and Doppler in critically ill patients, it can be technically difficult or inconclusive. In this setting, TEE provides a safe and powerful diagnostic tool that can help guide patient management.