Clinical Trial Summary
Critical care echocardiography is increasingly recognized as an essential skill for
intensivists to achieve during their training and fellowship. It serves to provide critical
information to guide clinical management in patients with hemodynamic collapse and
respiratory insufficiency. While transthoracic echocardiography (TTE) could be adequate for
assessment in most situations, patient factors such as body habitus, presence of chest drains
and tubes, presence of thoracic surgical dressings, requirement of high ventilatory support
may impede operators from obtaining satisfactory images for evaluation. Moreover, operators
in TTE require time and experience for adequate skill and technique acquisition. In specific
pathologies such as infective endocarditis, presence of thrombus in left atrial appendage,
and evaluation of intracardiac shunts, TEE has been shown to be superior to TTE for proper
and accurate diagnosis. Therefore, TEE is widely accepted as the preferred and essential
modality for echocardiographic examination especially in European countries. Countries such
as France and North American have included critical care TEE as a core curriculum in the
critical care training pathway.
In Hong Kong, only basic critical care echocardiography using TTE is required during training
and in clinical practice. TEE evaluation is mostly performed in cardiac surgery units by
cardiac anesthetists and in stable patients by cardiologists. Critical care TEE is seldom
performed by intensivists independently for hemodynamic assessment and evaluation of
cardiopulmonary failure. This study describes the safety, feasibility, and clinical utility
of critical care TEE by critical care fellows in a university-affiliated institute providing
tertiary care to the territory. With implementation of this essential technique in a single
center, this study serves to act as a generalizable guidance to achieve an ultimate goal of
incorporating this technique as core curriculum in critical care training in parts of the
world where critical care TEE is not well established.
