Feasibility, Safety, and Utility of Advanced Critical Care Transesophageal Echocardiography Performed by Pulmonary/Critical Care Fellows in a Medical ICU


      Competence in advanced critical care transesophageal echocardiography allows the intensivist to diagnose and manage cardiopulmonary failure when transthoracic echocardiography is not sufficient to answer the clinical question. This report describes the feasibility, safety, and utility of transesophageal echocardiography performed by pulmonary and critical care fellows in a medical ICU in critically ill patients who were mechanically ventilated.


      This longitudinal descriptive study of advanced transesophageal echocardiography was performed in patients who were mechanically ventilated. The complications and clinical utility of the examinations were abstracted from review of the image set, the written report, and the patient chart. Influence on diagnosis was classified as confirming the initial clinical diagnosis or identification of a new or unanticipated finding. Therapeutic impact was categorized as no change in therapy resulting from the study findings or as change in therapy resulting from the study findings.


      The examination was feasible in all patients in whom it was attempted, and there were no complications of the procedure. New or actionable findings were identified in 43 (28%) studies, and 109 (72%) studies confirmed the initial clinical diagnosis. The findings resulted in a change in clinical management in 58 (38%) patients.


      Critical care transesophageal echocardiography is feasible, safe, and has clinical utility. It can be safely and effectively performed by fellows within the context of their critical care training with faculty supervision. Pulmonary critical care fellowship training programs should consider introducing critical care transesophageal echocardiography as a useful clinical tool.

      Key Words


      MICU ( medical ICU), PCCM ( pulmonary/critical care), TEE ( transesophageal echocardiography), TTE ( transthoracic echocardiography)
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      Linked Article

      • Critical Care Echocardiography
        CHESTVol. 153Issue 2
        • In Brief
          We read with enthusiasm the study by Garcia et al1 published in CHEST (October 2017) describing the safety, feasibility, and clinical decisions made from advanced transesophageal echocardiographic studies performed by pulmonary and critical care fellows. We agree that both transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) are important tools in the intensivist’s armamentarium.2 However, we worry that trainees and advocates for critical care echocardiography could be misled by the findings, particularly with respect to TEE’s clinical utility.
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      • Response
        CHESTVol. 153Issue 2
        • In Brief
          We thank Bergl et al for their interesting commentary. Their perspective highlights some very important points. In response to the lack of inclusion criteria, our inclusion criteria were very simple: If we could not get adequate transthoracic echocardiographic (TTE) windows to determine the cause of the shock state or to guide our treatment, we chose to perform transesophageal echocardiography (TEE). This was our only inclusion criterion. In each patient, the view or views we were unable to acquire were different, but we were unable to answer the clinical questions needed to treat the patient.
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