The authors reply

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It was the panel’s intent to define the scope of care for bedside ultrasound in the ICU. As such Part 1 (1) and Part 2 (2) of recommendations cannot be reviewed in isolation. The term “Bedside Cardiac Ultrasound” (BCU) was therefore used to additionally emphasize our belief in the holistic nature of the bedside ultrasound in the ICU. Almost without exception multiple organ examinations are used to provide complementary information to assist in diagnosis and therapy monitoring of the critically ill. Obvious examples of this approach are a combination of cardiac ultrasound to assess right ventricular (RV) failure and the tributaries of inferior vena cava (IVC) for deep venous thrombosis. Lung ultrasound and fast are also typically used with cardiac evaluation. Thus, BCU differs in intend and emphases from traditional echocardiography.
We do agree that IVC condition is dependent on the right atrial and RV diastolic pressure in thus is not a strong predictor of fluid responsiveness. However, it is used for this purpose and had to be included. Please note that the panel was unable to reach consensus on this recommendation in sepsis. Perhaps other ways including carotid artery flow response to passive leg raising (not traditionally a part of echocardiographic examination) (3) will be able to provide additional information.
Finally, variability in local expertize in critical care ultrasonography around the world is staggering. This situation is likely to persist till standardized medical school curriculum for the bedside ultrasound is generally accepted and adopted (4). In issuing its recommendation, the panel had average American ICU practitioners in mind. This resulted in some minor deviations from the International Consensus Statement on training standards (5) Those differences were not meant to replace but to adopt the statement to a local situation. The panel looked at them as a “necessary evil” and tried to adhere to the above as much as possible. We believe that both documents are complimentary in nature and minor differences are stemmed from the difference in intend (scope of care vs training standards). We are thankful to the authors of the letter for bringing the above points to attention (6).
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