Open Letter to Manfred Ritter, President of the Working Group of Echocardiography, Swiss Society of Cardiology

I have read your annual report with great interest. As you know I have been engaged in perioperative (transoesophageal) echocardiography since 1989 [1] and involved in the education of intensive care unit (ICU) physicians (European Society of Intensive Care Medicine, ESICM) since 2003. I therefore feel the need to reply to your report on echocardiography in the ICU.

I would recall that ultrasound is being increasingly used in the intensive care unit (ICU) worldwide. Drug and fluid effects, the influence of artificial ventilation, patient positioning, and indication for and location of pleural drainage, are all very important indications for rapid ultrasound assessment of organ pathology and function [2]. This is the diagnostic power for us as intensivists, its result sometimes leading to a complete change in therapy within a few minutes [1]. All this is true 24 hours a day, 7 days a week, and frequently our goal-oriented use of ultrasound has to be repeated several times a day.

In conclusion, we need ultrasound in intensive care in addition to the tests performed by trained cardiologists, not instead of them. Hence I do not see that the diagnostic power of echocardiography is in danger of decay from its use in the ICU. Apparently this opinion is shared by many other Swiss doctors: at their November 2009 session all the delegates of the “Schweizerisches Institut für Ärztliche Weiter- und Fortbildung” (Swiss Institute of Further Medical Education) voted against the request to ban the use of echocardiography by intensive care doctors.

I strongly hope that in the second decade of this century we shall find joint solutions for the use of ultrasound in the ICU.