Visualization of the heart using echocardiography offers the advantage of direct measurement of cardiac volumes and systolic function. Echocardiography has been established as a tool to evaluate the causes of hemodynamic instability in ICU patients by the visualization of cardiac chambers, valves and pericardium and cardiac functional abnormalities. Transthoracic echocardiography (TTE) can be used as a first-line approach for a quick and focused examination to diagnose acute cor pulmonale, cardiac tamponade or major left ventricular systolic dysfunction. The training necessary to reliably perform such an abbreviated TTE use is substantial and the method is not readily available for every intensivist. Transesophageal echocardiography (TEE) can have a better diagnostic capability and is more reproducible than TTE. A minimum number of 31 TEE examinations has been reported to be required for intensivists to achieve competence in TEE driven hemodynamic evaluation of ventilated ICU patients. Additionally, repeatedly inserting the TEE probe as required for serial evaluation of a patients hemodynamic status is associated with a small but significant risk of injury to oral and esophageal structures. A repeated echocardiographic assessment could potentially provide useful additional information resulting in more rapid resolution of hemodynamic instability. Using conventional TTE and TEE, however, limits the feasibility of such an approach due to a lack of time and availability of appropriately trained staff.