RT Book, Section A1 Lakticova, Viera A1 Mayo, Paul H. A2 Levitov, Alexander B. A2 Mayo, Paul H. A2 Slonim, Anthony D. SR Print(0) ID 1106128859 T1 TRANSESOPHAGEAL ECHOCARDIOGRAPHY: IMAGE ACQUISITION AND TRANSDUCER MANIPULATION T2 Critical Care Ultrasonography, 2e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 978-0-07-179352-0 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1106128859 RD 2024/03/28 AB The value of performing transesophageal echocardiography (TEE) in the intensive care unit (ICU) is well established. Although transthoracic echocardiography (TTE) is a useful diagnostic tool in the ICU, TEE has superior diagnostic accuracy and therapeutic impact in several clinical situations, particularly for patients in shock states.1–3 Several authors have demonstrated that TEE findings lead to major therapeutic decisions between 43% and 68% of the time.1,4–6 TEE produces good image quality due to the position of the probe proximate to the heart, allowing for the use of higher frequency ultrasound with superior resolution of cardiac structures than with TTE. Although improvements in imaging, software, and portable systems have reduced the rates of inadequate image quality seen with TTE, there remain a significant percentage of patients in the ICU whose image quality with TTE is inadequate. Many factors account for this including inadequate patient positioning, lung hyperinflation, obesity, edema, and the presence of chest devices, wounds, and dressings. TTE results in adequate image quality in approximately 55% of mechanically ventilated ICU patients, with the remaining 23% and 22% of studies being of suboptimal and poor quality, respectively.3 In addition to overcoming poor image quality of TTE, TEE is often necessary for the evaluation of specific diagnoses in the ICU such as endocarditis, identifying an embolic source, intracardiac shunt, aortic dissection, and loculated pericardial effusion. For hemodynamic assessment, TEE is the only method to assess superior vena cava (SVC) variation, a predictor of volume responsiveness.7 When compared with helical computed tomography (CT), TEE has good sensitivity and specificity for central pulmonary embolism (PE) associated with right ventricular dilatation.8,9