Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit
Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit
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DOI：
10.1007/s00134-007-0742-8
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发表时间：
2007-10-01
影响因子：
38.9
通讯作者：
Gastinne, Herve
中科院分区：
文献类型：
--
作者：
Vignon, Philippe;Dugard, Anthony;Gastinne, Herve
Objective: We sought to evaluate the efficacy of a limited training dedicated to residents without knowledge in ultrasound for performing goal-oriented echocardiography in ICU patients. Design: Prospective pilot observational study. Setting: Medical-surgical ICU of a teaching hospital. Patients: 61 consecutive adult ICU patients (SAPS II score: 38 +/- 17; 46 ventilated patients) requiring a transthoracic echocardiography were studied. Interventions: After a curriculum including a 3-h training course and 5 h of hands-on training, one of four noncardiologist residents and an intensivist experienced in ultrasound subsequently performed hand-held echocardiography (HHE), independently and in random order. Assessable" rule in, rule out" clinical questions were purposely limited to easily identifiable conditions by the sole use of two-dimensional imaging. Measurements and results: When compared with residents, the experienced intensivist performed shorter examinations (4 +/- 1 vs. 11 +/- 4min: p < 0.0001) and had significantly less unsolved clinical questions [3 ( 0.8%) vs. 27 (7.4%) of 366 clinical questions: p < 0.0001]. When addressed, clinical questions were adequately appraised by residents: left ventricular systolic dysfunction [Kappa: 0.76 +/- 0.09 (95% CI: 0.59 - 0.93)], left ventricular dilatation [Kappa: 0.66 +/- 0.12 (95% CI: 0.43 - 0.90)], right ventricular dilatation [Kappa: 0.71 +/- 0.12 ( 95% CI: 0.46 - 0.95)], pericardial effusion [Kappa: 0.68 +/- 0.18 ( 95 CI: 0.33 - 1.03)], and pleural effusion [Kappa: 0.71 +/- 0.09 ( 95% CI: 0.53 - 0.88)]. The only case of tamponade was accurately diagnosed by the resident. Conclusions: Limited training of noncardiologist ICU residents without previous knowledge in ultrasound appears feasible and efficient to address simple clinical questions using point-of-care echography. Influence of the learning curve on diagnostic accuracy and potential therapeutic impact remain to be determined.
