title: Transesophageal echocardiography in critically ill patients.
abstract: OBJECTIVE
  To evaluate the safety and utility of transesophageal echocardiography performed by intensive care physicians in critically ill patients.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  A 24-bed multidisciplinary adult intensive care unit in a 692-bed tertiary referral teaching hospital.
  
  
  METHODS
  Two hundred fifty-five intensive care patients.
  
  
  METHODS
  We studied 255 consecutive intensive care patients who underwent transesophageal echocardiography between January 1996 and January 2000.
  
  
  RESULTS
  Three hundred eight transesophageal echocardiography studies were successfully performed; the probe could not be passed in one patient with a cervical fracture. The indications included unexplained hypotension (40%), known or suspected endocarditis (27%), assessment of ventricular function (15%), pulmonary edema (5%), source of embolus (4%), assessment of aorta (4%), and other (5%). In 67% of hypotensive patients, transesophageal echocardiography revealed the cause of hemodynamic instability, leading to a management change and improvement in blood pressure in 31%. This included surgery in 22% without the need for additional tests. Overall, transesophageal echocardiography findings led to a significant change in management in 32% of all studies performed. One patient receiving continuous positive airways pressure suffered pulmonary aspiration during tracheal intubation before transesophageal echocardiography, two patients had hypotension associated with sedative medication, and there was one case of oropharyngeal bleeding after probe insertion.
  
  
  CONCLUSIONS
  Transesophageal echocardiography when performed by intensive care physicians is a safe procedure and provides useful information for the evaluation and management of critically ill patients.
authors: Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia.
authors: Frances B
authors: FB
authors: Colreavy
authors: Karl
authors: K
authors: Donovan
authors: Kok Yeng
authors: KY
authors: Lee
authors: John
authors: J
authors: Weekes
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000000981:diagnostic imaging; D016638:Critical Illness; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000000981:diagnostic imaging; D004696:Endocarditis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012449:Safety; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging