January 2015

Clinical data exist on the usefulness of TEE and TTE in adult patients in critical care units or emergency departments who are hemodynamically unstable or who need noninvasive hemodynamic monitoring. However, prospective, randomized clinical trials are lacking on the morbidity, mortality, and cost effectiveness of echocardiography in this population. Because of the ethical and logistic challenges in conducting randomized clinical trials on patients who are hemodynamically compromised, expert opinion is heavily relied on for criteria and guidelines. Although expert opinion and a significant body of literature support the use of echocardiography as a tool to guide therapy in patients who are critically ill, standard guidelines that define when and how echocardiography can be used to guide medical and surgical therapy have not been published. This document summarizes the literature that supports the use of echocardiography as a monitoring tool in specific clinical settings. The specific parameters that are used are discussed first, followed by guidelines for their use in specific clinical scenarios