Evaluation of hypoxemic patients with transesophageal echocardiography

OBJECTIVE: To summarize the use of transesophageal echocardiography when investigating hypoxemic patients in the intensive care unit, to assess its risks and benefits, and to evaluate which diseases of the cardiopulmonary system, mediastinum, and thorax it will help to guide therapeutic decisions. DESIGN: A review of current literature and practice guidelines was performed. RESULTS: Hypoxemia, due to a number of different reasons, is common in critically ill patients. Many diagnoses and therapeutic decisions have to rely on good-quality imaging. However, transthoracic echocardiography often produces poor-quality pictures; other imaging modalities involve transferring unstable patients to the imaging suite. Transesophageal echocardiography can safely be performed at the bedside and generates excellent image quality. CONCLUSION: Transesophageal echocardiography is a safe procedure that can be performed at the bedside and that produces high-quality images of the heart, its related structures, and its function. It helps detect extracardiac pathology leading to hypoxemia and may be used to guide fluid resuscitation and optimize tissue oxygenation.