Transesophageal echocardiography in critically-ill patients using a miniaturized probe: feasibility, efficacy and indications.

Transesophageal echocardiography (TEE) with standard probes may be unsuccessful in emergencies, and in critically-ill or non collaborative patients. A miniaturized pediatric probe was used to overcome these limitations. Thirty-nine patients (age 18-87 years, height 155-184 cm, weight 45-102 kg) were studied with the pediatric probe, and 21 of them were studied using both the pediatric and adult probes in a random sequence. Feasibility, efficacy and patient's compliance were assessed. The use of the pediatric probe was mandatory in 18 critically-ill and/or non collaborative patients for the following reasons: contraindication to sedation in 15 patients with respiratory failure and/ or with unstable hemodynamics (12 not intubated patients) or patients undergoing electroencephalographic monitoring (3 intubated patients); inability to advance the probe into the esophagus in 1 patient with esophageal compression from intrathoracic struma and in 2 patients with stenosing esophageal cancer. Imaging projections and diagnostic accuracy in a wide range of cardiac, aortic and mediastinal diseases were similar for both the pediatric and adult probes. Patient's compliance was much improved by the pediatric probe. In conclusion, TEE by pediatric probes can be used in critically-ill adult patients when the approach with the standard probe is unfeasible or when sedation is undesirable.