Transthoracic echocardiography is not cost-effective in critically ill surgical patients

BACKGROUND: Echocardiography has been shown to be valuable in critically ill surgical patients. Transthoracic echocardiography (TTE) often fails to provide adequate imaging in critically ill patients, necessitating subsequent transesophageal echocardiography (TEE). The objective of this study was to determine and quantify factors associated with failure of transthoracic echocardiography (TTE) in critically ill surgical patients, and to define a cost-effective strategy for echocardiography in these patients. METHODS: Demographic and clinical data were collected retrospectively and evaluated to determine which factors were associated with failure of TTE to provide adequate imaging. In addition, models were developed to estimate costs for echocardiography in critically ill surgical patients. RESULTS: TTE has a high failure rate in critically ill surgical patients. This failure rate increases significantly in patients who gain > 10% body weight from admission weight, who are supported with > or = 15 cm H(2)O positive end-expiratory pressure, and in those with chest tubes. As a result, the use of TTE in critically ill surgical patients is not cost-effective. TEE, however, is highly effective in this group of patients, and is more cost-effective than TTE in evaluating those critically ill surgical patients requiring echocardiography. CONCLUSION: The routine use of TTE to initially evaluate all critically ill surgical patients who require echocardiography should be abandoned because it is not cost-effective. TEE appears to be the most cost-effective echocardiographic modality in the surgical intensive care unit.