Changing Patterns of Transesophageal Echocardiography Use in the Intensive Care Unit

Since its advent, the use of transesophageal echocardiography (TEE) has grown rapidly. In patients undergoing TEE in the intensive care unit over two time periods (4 years apart), we evaluated whether TEE led to new/unsuspected findings or changes in patient management. Results showed that the indications for which patients underwent TEE changed considerably between the two time periods. Hemodynamic instability was an indication for TEE in 41% of the patients in the first interval and 56% of the patients in the second interval. TEE frequently established a new diagnosis (41%) and led to significant management changes (28%) in both time periods. These changes occurred despite the use of a pulmonary artery catheter in nearly 2/3 of the patients studied. Therefore, despite increasing and changing use, TEE frequently establishes unsuspected diagnosis and directly influences patient management when used in intensive care patients.