Contrast echocardiography in the cardiac care unit

Suboptimal echocardiograms are common in critically ill patients. The obstacles that interfere with optimal echocardiographic imaging in cardiac care unit patients include suboptimal positioning, obesity, hyperinflated lungs due to mechan- ical ventilation, lung disease, subcutaneous emphysema, surgical incisions, chest tubes, bandages, and crowded quarters. It is well known that use of contrast in echo- cardiography significantly improves the image quality, but despite that, contrast echocardiography is widely underused. The current chapter outlines the basics of contrast echocardiography as it applies to critical care.