Abstract
Rationale and objectives
To evaluate limited training of ICU physicians without knowledge of ultrasound in performing basic general ultrasonography.
Design and setting
A prospective, observational, study conducted in a 14-bed MICU.
Patients
Seventy-seven critically ill patients (38 females) aged 64 ± 16 years, with a SAPS II score of 47 ± 21, 49 of whom (64%) were receiving mechanical ventilation.
Methods
After 8.5 h of training comprising a 2.5 h didactic course that included essential views of normal and pathologic conditions and three hands-on sessions of 2 h each, one of eight ICU residents and the radiologist on duty performed the same examination in a blind manner. The questions addressed concerned the presence of pleural effusion, intra-abdominal effusion, acute cholecystitis, intrahepatic biliary duct dilation, obstructive uropathy, chronic renal disease, and deep venous thrombosis.
Measurements and main results
The answers to 129 questions were analyzed. The possible presence of pleural effusion, and arguments for the presence of urinary tract obstruction and chronic renal insufficiency, were the questions most frequently addressed. Residents answered 84.4% of the questions correctly [Kappa: 0.66, CI 95% (0.32–1.12)]. Most of the discrepancies concerned small non-drainable pleural or abdominal effusions. For questions with a potential therapeutic impact, residents answered 95% of the questions correctly [Kappa 0.86, CI 95% (0.75–1.04)]. Residents completed the examination in 37 ± 39 min compared with 296 ± 487 min for the radiologists (P = 0.004).
Conclusions
These results suggest that after brief focused training, intensive-care unit physicians without previous knowledge of ultrasonography can competently perform basic general ultrasonic examinations.
References
Vieillard-Baron A, Charron C, Chergui K, Peyrouset O, Jardin F (2006) Bedside echocardiographic evaluation of hemodynamics in sepsis: is a qualitative evaluation sufficient? Intensive Care Med 32:1547–1552
Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F (2003) Hemodynamic instability in sepsis: bedside assessment by Doppler echocardiography. Am J Respir Crit Care Med 168:1270–1276
Vieillard-Baron A, Slama M, Cholley B, Janvier G, Vignon P (2008) Echocardiography in the intensive-care unit: from evolution to revolution? Intensive Care Med 34:243–249
Vignon P, Dugard A, Abraham J, Belcour D, Gondran G, Pepino F, Marin B, Francois B, Gastinne H (2007) Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive-care unit. Intensive Care Med 33:1795–1799
Charron C, Prat G, Caille V, Belliard G, Lefevre M, Aegerter P, Boles JM, Jardin F, Vieillard-Baron A (2007) Validation of a skills assessment scoring system for transesophageal echocardiographic monitoring of hemodynamics. Intensive Care Med 33:1712–1718
Schacherer D, Klebl F, Goetz D, Buettner R, Zierhut S, Schoelmerich J, Langgartner J (2007) Abdominal ultrasound in the intensive-care unit: a 3-year survey on 400 patients. Intensive Care Med 33:841–844
Lichtenstein D, Axler O (1993) Intensive use of general ultrasound in the intensive-care unit. Prospective study of 150 consecutive patients. Intensive Care Med 19:353–355
Slasky BS, Auerbach D, Skolnick ML (1983) Value of portable real-time ultrasound in the ICU. Crit Care Med 11:160–164
Jang T, Sineff S, Naunheim R, Aubin C (2004) Residents should not independently perform focused abdominal sonography for trauma after 10 training examinations. J Ultrasound Med 23:793–797
Shackford SR, Rogers FB, Osler TM, Trabulsy ME, Clauss DW, Vane DW (1999) Focused abdominal sonogram for trauma: the learning curve of nonradiologist clinicians in detecting hemoperitoneum. J Trauma 46:553–562 discussion 562–554
Vigneau C, Baudel JL, Guidet B, Offenstadt G, Maury E (2005) Sonography as an alternative to radiography for nasogastric feeding tube location. Intensive Care Med 31:1570–1572
Maury E, Guglielminotti J, Alzieu M, Guidet B, Offenstadt G (2001) Ultrasonic examination: an alternative to chest radiography after central venous catheter insertion? Am J Respir Crit Care Med 164:403–405
Doelken P, Strange C (2003) Chest ultrasound for “Dummies”. Chest 123:332–333
Vignon P, Frank MB, Lesage J, Mucke F, Francois B, Normand S, Bonnivard M, Clavel M, Gastinne H (2004) Hand-held echocardiography with Doppler capability for the assessment of critically-ill patients: is it reliable? Intensive Care Med 30:718–723
Manasia AR, Nagaraj HM, Kodali RB, Croft LB, Oropello JM, Kohli-Seth R, Leibowitz AB, DelGiudice R, Hufanda JF, Benjamin E, Goldman ME (2005) Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients. J Cardiothorac Vasc Anesth 19:155–159
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Chalumeau-Lemoine, L., Baudel, JL., Das, V. et al. Results of short-term training of naïve physicians in focused general ultrasonography in an intensive-care unit. Intensive Care Med 35, 1767–1771 (2009). https://doi.org/10.1007/s00134-009-1531-3
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DOI: https://doi.org/10.1007/s00134-009-1531-3