Competence in image acquisition of the following standard views is required: parasternal long and short axis views, apical four-chamber view, subcostal four-chamber view, and inferior vena cava (IVC) view. Table 6 summarizes the image interpretation skills required for competence in basic CCE. Competence in cognitive skills required for application of image interpretation results requires knowledge of the common clinical indications for the study. These include evaluation and management of hemodynamic instability, shock, cardiac arrest, unsuccessful response to acute therapy, and respiratory failure. Competence in basic CCE requires that the intensivist have the cognitive training to integrate echocardiography into management strategy. This requires recognition of the echocardiographic patterns listed in Table 7. Requirements for competence in image interpretation include qualitative assessment of left ventricular (LV) cavity size (small, normal, or severely dilated), LV systolic function (normal, hyperdynamic, mild-to-moderate dysfunction, or severe dysfunction), and distinguishing homogeneous from heterogeneous patterns of LV contraction. Qualitative assessment of global right ventricular (RV) cavity size and function using the parasternal short-axis and apical four-chamber views (normal vs dilated, when RV size exceeds LV size); identification of pericardial fluid (with distinction from pericardial fat, pleural effusion, and ascites); and 2D findings consistent with tamponade physiology (right atrial/RV diastolic collapse, and dilated, noncollapsible IVC in spontaneously breathing patients) are requirements for competence. Measurement of IVC diameter (between the right atrial junction and the superior hepatic vein) and qualitative assessment of its respiratory variations (present or absent) in the subcostal view, including knowledge of problems with adequate interpretation of IVC dynamics (distinction from the abdominal aorta and effects of mechanical ventilation and of elevated intraabdominal pressure), are part of competence. Competence in basic CCE includes qualitative assessment of valve function using color Doppler to assess for severe valvular regurgitation. Competence in basic CCE does not include use of color or spectral Doppler for comprehensive assessment of valvular or hemodynamic function, definitive identification of isolated mild to moderate LV dysfunction, identification of specific segmental wall dysfunction, RV dysfunction in the absence of RV dilatation, or identification of abnormal or paradoxical interventricular septal motion pattern. The intensivist must also have knowledge as to when to identify an indeterminate result that may require consultation with a more advanced echocardiographer.