[Transesophageal echocardiography for non-cardiac surgery patients: superfluous luxury or essential diagnostic tool?]

Abstract

Background: The value of transesophageal echocardiography (TEE) in non-cardiac critically ill patients has barely been studied.

Materials and methods: Over a period of 4 years TEE was used prospectively to evaluate patients with acute hemodynamic instability in non-cardiac critically ill patients in addition to standard care.

Results: A total of 363 TEE studies were performed in 339 selected patients. Volume depletion (169/47%) and regional wall motion abnormalities (97/27%) were the most frequent findings followed by global left ventricular dysfunction (79/22%). Of the TEE studies, 203 (56%) provided additional information with therapeutic relevance in 164 (45%) cases.

Conclusions: Transesophageal echocardiography provides additional information in critically ill non-cardiac patients with unexplained hemodynamic instability. In the majority of cases a clinical diagnosis is confirmed or improvement of volume resuscitation and catecholamine therapy can be achieved. In the minority of patients the results of TEE lead to distinct changes in medical management. Whether this improved diagnostic accuracy favours outcome, still needs to be evaluated.