Evaluation of transesophageal echocardiography as a diagnostic and therapeutic aid in a critical care setting.

OBJECTIVES To assess the impact of transesophageal echocardiography (TEE) on therapeutic management in relation to pulmonary artery catheterization (PAC) in the ICU. DESIGN Retrospective analysis of 108 consecutive TEE video and related patient files during a 7-month period. SETTING A 33-bed medical and surgical ICU. METHODS All critically ill patients with or without PAC in whom a TEE was performed, excluding postoperative cardiac surgical patients. Patients were divided in a cardiac and a septic group depending on the primary disease on admission to the ICU. The impact of TEE in relation to PAC on ICU management was evaluated in whether therapy changes were performed strictly on the basis of the TEE findings. MAIN RESULTS Of 64% of patients with a PAC, 44% underwent therapy changes after TEE: 41% in the cardiac and 54% in the septic subgroup. In 41% of patients without a PAC, TEE led to a change in therapy. CONCLUSIONS TEE results in altered therapeutic management in at least one third of our (noncardiac surgery) ICU patient population independent of the presence of a PAC.