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

Abstract

Patients in the ICU are often technically difficult to study by transthoracic echocardiography. In these patients, efforts should be made to achieve adequate optimization of images. The following steps can be followed to achieve this: (1) minimizing patient-related disturbing factors; (2) optimizing machine settings; (3) approaching the patient using multiple and alternative views; and (4) utilizing echocardiographic indexes that are less dependent on image quality. Using this approach, one can study most patients adequately without the need to resort to transesophageal echocardiography. However, transesophageal echocardiography remains of key importance in doubtful cases, and in selected cases should be considered as a first-line examination.