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Opinions/Hypotheses |

Hemodynamic Monitoring Utilizing Transesophageal Echocardiography*: The Relationships Among Pressure, Flow, and Function

Jan I. Poelaert, MD, PhD, FCCP; Guido Schüpfer, MD
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*From the Department of ICU (Dr. Poelaert), University Hospital, Gent, Belgium; and Klinik für Anästhesie und Operative Intensivmedizin (Dr. Schüpfer), Kantonsspital, Luzern, Switzerland.

Correspondence to: Jan Poelaert, MD, PhD, FCCP, Cardiac Anaesthesia and Postoperative Cardiac Surgical ICU, Department of ICU, University Hospital, De Pintelaan 185, B9000 Gent, Belgium; e-mail: jan.poelaert@ugent.be



Chest. 2005;127(1):379-390. doi:10.1378/chest.127.1.379
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Extract

Cardiac imaging is an important cornerstone in decision making and management in cardiovascular medicine. Echocardiography and Doppler ultrasonography developed as the main and most commonly used bedside imaging techniques. Transthoracic echocardiography is an invaluable imaging technique with respect to the diagnosis of cardiovascular disease. The impact of echocardiography on the change in the therapy and management of hospitalized patients was found to be as high as 57%, although changes occurred more frequently in ICU patients compared to those admitted to the hospital (54% vs 37%, respectively).12 Nevertheless, the transthoracic approach for echocardiography has certain specific limitations regarding the visualization of different cardiac structures and great vessels. Table 1 demonstrates in detail the potential advantages and shortcomings of both techniques. Transesophageal echocardiography (TEE) with Doppler imaging has opened a completely different window, and has become a fascinating and appealing tool, not only for diagnosis in routine cardiology practice3 but also for perioperative hemodynamic monitoring, having a decisive impact on surgical management. Moreover, owing to its bedside availability, TEE facilitates the routine diagnosis and management of cardiovascular failure both intraoperatively and in ICU patients.4

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