[Echocardiography for hemodynamic monitoring on ICU?]

A goal-directed hemodynamic therapy (GDT) using volume substitution and/or cardiovascular agents in order to increase stroke volume and consecutively tissue oxygenation has been shown to reduce perioperative complications. Previous hemodynamic monitoring devices mostly are only able to detect a restriction in several parameters of cardiovascular function not always diagnostically conclusive to their pathophysiological cause. However, this is mandatory for GDT. In this context, discontinuous transthoracic (TTE) and transesophageal (TEE) echocardiography is gaining clinical relevance. In addition, recently there exists the opportunity to perform a continuous hemodynamic focused transesophageal echocardiography ("hemodynamic TEE", hTEE) via a miniaturized monoplane probe. With its flexible probe tip the three most important two-dimensional views of the heart can be obtained to differentiate between aforementioned pathophysiological causes of a low cardiac output syndrome. It is introduced orally in the patient's esophagus and can remain up to 72 hours in situ. First clinical reports/studies were able to demonstrate that a short intensive training programme for physicians unexperienced in echocardiography was sufficient to adequately initiate GDT. However, further studies have to prove the clinical feasibility and the positive effect on patient's outcome.