POINTS OF VIEWpatients. More interest in the use of echocardiography in

the ICU followed the general clinical introduction of tran-soesophageal echocardiography (TOE) in the late 1980s. At that time, TOE had unquestionably better imaging ability in ventilated patients than TTE. Furthermore, it had unmatched clinical utility in the ICU management of cardiac surgical patients, and in the diagnosis of specific problems, (eg, aortic root abscess and acute dissection). Recent studies show that consultant intensivists can be taught to perform echocardiography safely and accurately on ICU patients.4,5 The success of these ICU echocardiogra-phy programs was predicated on a supportive and coopera-tive relationship with cardiologist echocardiographers, and a consultant intensivist cohort willing to invest substantialEchocardiography and the critically ill The first reports directly addressing the use of tr echocardiography (TTE) in the ICU were publish and included an investigation of myocardial dys septic shock.1,2 Although the clinical utility of ecCritical Care and Resuscitation • Volusuch as prosthetic valvular dysfunction, endocarditis and thoracic aortic dissection. Advances in ultrasound technology have narrowed the gap between the imaging quality obtained by TOE and TTE in the ventilated critically ill patient. TTE can now be considered the echocardiographic modality of first choice for imaging in most ICU patients, including those with sepsis, as the image quality and structural and functional information obtained is usually sufficient for initial evalua-tion.3 Importantly, TTE avoids the serious, albeit uncommon, complications of TOE (eg, oesophageal and gastric perfora-tion and haemorrhage), and can be set up and performed in a third of the time or less. TOE should be reserved for patients for whom TTE image quality is insufficient to answer the relevant clinical question(s), and for specific indications, such as complex cardiac structural and valvular abnormalities (eg, endocarditis, prosthetic valve dysfunction and congenital abnormalities), or thoracic aortic pathologyCrit Care Resuscitation ISSN: 1441-2772