A systematic approach to transoesophageal echocardiography in the intensive care unit – a practical guide for intensivists

Transoesophageal echocardiography (TOE) has become a useful diagnostic and monitoring tool in critical care settings, especially when transthoracic echocardiography is difficult to perform. It gives valuable information in mechanical ventilation, especially in the prone position, in obese patients, and in patients with surgical dressings and chest tubes. Transthoracic echocardiography allows visualization of deep cardiac structures and their pathologies. It has extensive diagnostic implications. This article describes the systematic approach to critical care TOE examination with a detailed description of the views necessary for rapid haemodynamic assessment in critical care patients. It is concordant with European Diploma in Advanced Echocardiography (EDEC) requirements, and its structural approach is based on the author’s experience acquired in the EDEC examination process. Performing TOE in an organized fashion can help to pinpoint most of the pathologies and monitor the treatment process in the intensive care unit.