There are multiple indications to use ultrasonography in the ICU; specifically for echocardiography the general indications for performing such an exam are listed in Table 18-1.¹,²

There are some situations in which TTE is superior over TEE and vice versa. Regarding TTE, the advantages are portability, widespread availability, and rapid diagnostic capabilities.¹,³,⁴ The disadvantages include the inherent limitations of patients in the ICU setting that limit the quality of the acoustic window; these are listed in Table 18-2. The reported failure rate for TTE is up to 40% in this setting,⁵,⁶ although recent studies using contrast, harmonics and digital imaging technologies have improved this percentage.⁷,⁸,⁹

TEE is very useful for assessment of the aorta (except the arch), heart valves, sources of cardiac emboli, intracardiac shunts, and unexplained hypotension. Furthermore, TEE has a vital role in the evaluation of the performance, placement, and complications of novel techniques such as ventricular assist devices (VADs). Nowadays the ACC/AHA/ASE Guidelines give a Class I evidence rating to a majority of the pathologies that are currently prevalent in (cardiac) ICUs. A list of current indications for performing a TEE exam is given in Table 18-3.¹,²,³,⁴,¹⁰,¹¹,¹²,¹³,¹⁴,¹⁵,¹⁶,¹⁷,¹⁸,¹⁹,²⁰,²¹,²²,²³,²⁴

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