Transesophageal echocardiography in resuscitation. Indications and presentation of various clinical cases

The diagnostic potential of Transesophageal Echocardiography (TEE) is well established in patients with suspicion for some life-threatening diseases as cardiogenic cerebral embolization, aortic dissection, intracardiac or thoracic masses, acute valvular dysfunction or sepsis of undetermined origin, which represent a relevant part in the activity of Intensive Care Units (ICU). Thus, an increasing role of TEE may be foreseen in this arena, also due to some of the known odds of ultrasound techniques compared to other imaging tools like CT scan or MRI (lower cost and beside availability). The aim of the present paper is to briefly review the main indications for TEE in ICU, and to report on some illustrative cases from our experience of I year in this field. Twenty-eight seriously-ill patients referred to our ICU between December 1991 and December 1992 were investigated for 1 of the following diagnostic problems: a) chest trauma with suspicion for aortic dissection and/or mediastinal bleeding; b) sepsis of undetermined origin; c) cerebral transient ischemic attack or stroke; d) assessment of cardiac function in potential heart donors. TEE was performed by means of commercially available instruments (either Hp Sonos 1500 or Esaote Sim 7000 Color Flow Mapping), with conventional monoplane probe or so-called wide-angle, "panoramic" probe, respectively. In most of the patients studied, TEE provided either unique or complementary, diagnostically useful, information. By panoramic approach, which yields imaging field up to 270 degrees, a comprehensive visualization of the heart, aorta and mediastinal structures was possible.(ABSTRACT TRUNCATED AT 250 WORDS)