The role of transoesophageal echocardiography (TOE) in a general intensive care unit was examined by reviewing all studies performed in a major metropolitan hospital over a two-year period. TOE was performed on 53 patients where transthoracic studies were inadequate, the indications being cardiac source of embolus (13/53), thoracic aorta abnormalities (5/53), left ventricular systolic function (22/53), endocarditis (6/53), right heart pathology (2/53), pulmonary embolus (2/53), or a potentially surgical correctable lesion (3/53). Findings were categorized into three groups: confirming suspected pathology (18/53), major incidental findings (6/53), or normal (29/53). Patient management was altered, not only by the finding of positive pathology, but also after identifying normal left ventricular systolic function (14/53). Echocardiography has become an invaluable tool in the ICU setting.