Comment on Vieillard-Baron et al.: “Bedside echocardiographic evaluation of hemodynamics in sepsis: is qualitative evaluation sufficient?”

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Sir: Vieillard-Baron and colleagues are to be congratulated for their demonstration of the clinical importance of transesophageal echocardiography (TEE) in septic shock [1]. They show how a qualitative study can yield useful clinical information without requiring advanced quantitative measurements. However, I would suggest that things could be simplified even further by using transthoracic echocardiography (TTE). A limited transthoracic study can be carried out on the majority of critically ill patients, with TEE reserved for the small proportion with poor windows or requiring more detailed examination. Previous studies have shown TEE to yield additional information to TTE in some cases [2], but increasing sophistication of newer portable machines may decrease this number. TEE will usually require sedation in the awake patient, making the procedure impractical in many circumstances. TEE is associated with a small numbers of serious complications, and additional concerns arise with probe decontamination [3]. …