Answer to the Open Letter of PD Dr. D. Schmidlin

Thank you for your interest in our Working Group’s annual report for 2009.

As you pointed out, your interest and criticism focuses on the statement concerning the use of goal-oriented echo studies by intensive care physicians, and the possibly inherent decay the diagnostic power of echocardiography may undergo with such use.

As you will agree, it goes without saying that goal-oriented echo studies and comprehensive echocardiographic examinations are two totally different matters.

Goal-oriented echo studies imply by their nature some risk of diagnostic errors [1], and this possibility is even increased in the ICU environment where patients, due to mechanical ventilation and for other reasons, are often anything but easy to image; there is no question that relatively inexperienced ultrasound operators would potentiate even more the risk of missing a relevant diagnosis. And this, you will agree, cannot be the ultimate goal when it comes to the point-of-care. Hence, the question is not whether echocardiography should be used in intensive care medicine or not, but what is the setting for appropriate use of echo in the ICU.

The American Society of Echocardiography has prescribed a specified level of training [2] to resolve the problem, and I would suggest that echocardiography in the ICU should be performed under close collaboration/supervision with a cardiologist, to ensure an optimum diagnostic and, hence, therapeutic assessment in these critically ill patients. In this context, Swiss doctors’ view on whether or not echo be used by intensive care physicians is of purely political relevance.