The Use of Echocardiography in the Intensive Care Unit

Echocardiography is a powerful diagnostic tool that has become an indispensable part of intensive care medi cine. There is a broad clinical application for the noninva sive real-time structural and functional assessment of the critically ill patient. The echocardiograph provides on-line visual information and software for data manipu lation at the intensive care bedside without significant discomfort or risk. Assessment of ventricular function, hemodynamics, pericardial pathology, valvular status, and the outcomes of cardiac surgical interventions are naturally suited to this modality. Transesophageal echo cardiography is an important adjunct to the standard transthoracic examination, particularly in those pa tients with inadequate precordial images. Anatomic, physiologic, and hemodynamic findings can be corre lated in a variety of clinical conditions to make and confirm diagnoses and to direct management in a manner complementary to routine intensive care. Indi cations for echocardiography in the intensive care unit at this institution included assessment of ventricular function, valvular function, endocarditis, complications of surgery, abnormal hemodynamics, evaluation of intra cardiac source of embolus, and echocardiographic-guided endomyocardial biopsy. In this review, the tech niques, indications, and clinical applications of transthoracic and transesophageal echocardiography in the intensive care setting are explored, with a focus on experience in the cardiac surgical patient.