Transthoracic Echocardiography in the ICU: The Patient Who Is Difficult to Study

Abstract

Transthoracic echocardiography (TTE) plays a major clinical role in the management of intensive care unit patients. However, it is well known that critically ill patients are often difficult to study by TTE as a result of several factors, including supine decubitus and mechanical ventilation. Although to date the recent technological advances allow to obtain adequate TTE information in most patients, a correct knowledge of the techniques used to optimize images, facilitate their interpretation, and get adequate data even in patients with suboptimal acoustic windows is of major clinical importance. For patients in whom TTE does not provide adequate data, transoesophageal echocardiography (TEE) often provides additional information. However, care is needed to avoid inappropriate requests of TEE. In this chapter, we briefly review simple methods to be used for TTE examinations, aimed at minimizing patient’s related disturbing factors, optimizing instrumental settings, approaching the patient using alternative views, and utilizing indexes that are less sensitive to image quality.