Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit


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Abstract

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 ± 4 min: 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.

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