Dr. Wagner, thank you for taking part in this interview. We value the time you have taken to inform our readers on the way in which  hTEE is used today.

1. Can you share with us some of your general thoughts on the direction of critical care medicine as it relates to hTEE?

As we know, in Europe, echocardiography has been the cornerstone of the physical exam. We have fallen behind in the United States. With the newer technologies now which include hTEE, it has become increasingly evident that we must include TEE in the physical exam.  The limiting factor is education, and that's going to be where our focus is. In fact, we are starting an echo program for our critical care fellows starting in July that will include hTEE management, and I think that this is going to become more of the 'norm' and the standard.

2. Can you share with us any 'great saves' that you had with our device, either from your unit or another?
I can think of several published case reports that deal with hemodynamic hTEE in the critically ill, especially in cardiac surgery for the evaluation of pericardial effusion and assessments for returning to the operating room. We have had several episodes in hypothermia, in hypothermia cardiac surgery and in sepsis where it has been beneficial.

One that comes to mind was the use of hTEE to help guide management of a septic patient with RV dysfunction, recently accepted for publication in ICU Director.

3. Question on that case: I am wondering whether, in effect, are we learning how to better optimize cardiac performance on the first day, especially since there is a study from Levy et. al. that says Day 1 improvement in cardiac performance is a very good predictor of whether you will recover from septic shock?
I think that is part of the challenge, with no evidence to change mortality in sepsis. There is no device where that has been shown to change mortality, but we know that, if you do the right thing early on, you are giving the patient the best chance for survival. And that's where echo gives you direct knowledge of what is going on with the myocardium, for preload and contractility. That was especially poignant in the case report which was just accepted for ICU Director of a septic patient with RV dysfunction, and instead of continuing with fluid challenges as we were doing based on non-invasive monitoring, we added inotropic support for the right ventricle. 

The hTEE case studies provided in this newsletter illustrate the effectiveness of hTEE technology in contrast to indirect monitoring devices commonly used in critical care. In the studies presented, hTEE enabled an accurate assessment of cardiac performance and enabled effective fluid management.