[The usefulness of transesophageal echocardiography in general intensive care units]

It's well known the utility of transesophageal echocardiography in the evaluation of cardiological patients that are critically ill. However, there is less experience about this usefulness in non-cardiological critically ill patients.

To assess the utility and safety of the method we analyzed 51 correlative studies of patients admitted to our general Intensive Care Unit. Forty-seven patients (92%) were on mechanical ventilation and in 24 patients (47%) continuous assessment of the hemodynamic variables were available.

The most frequent diagnoses on admission were sepsis (23.5%) and shock status (17.6%). The indications were: suspicion of endocarditis (15 patients), hemodynamic instability (11 cases), cardiac source of embolus (10), suspicion of cardiac tamponade (4), suspicion of aortic dissection (4) and other causes in 7. The study confirmed the clinical suspicion in 31 cases (60.8%), excluded it in 15 (29.4%) and established a new, non-suspected, diagnosis in 5 patients (9.8%). There were major diagnostic changes in 16 patients (31.6%) and minor changes in 17 (33.3%) comparing the results of the transesophageal and transthoracic approaches. It was also assessed the influence of the result on the clinical management of the patient: in 32 cases (62.8%) there were a significant change in the treatment; in 5 patients (9.8%) cardiac surgery was prompted by echocardiography. Only in 3 patients hypertensive reactions and tachycardia were detected, without posterior consequences.

Transesophageal echocardiography can be safely performed and has a definite role in the diagnosis (showing sometimes non-suspected abnormalities) and management of non-cardiological critically ill patients.