Is Contrast Echo Safe for the Critically Ill Patient?

“Isn’t there a black box warning for contrast?” “I don’t feel comfortable giving contrast to my ICU patient” “The patient has acute coronary syndrome, I don’ think you should give contrast”  These are just a few of the responses you may face from an ICU nurse or critical care staff in response to your decision to perform a contrast echocardiogram.  So what’s the deal?