title: Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit.
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.
  
  
  METHODS
  Prospective pilot observational study.
  
  
  METHODS
  Medical-surgical ICU of a teaching hospital.
  
  
  METHODS
  61 consecutive adult ICU patients (SAPS II score: 38 +/- 17; 46 ventilated patients) requiring a transthoracic echocardiography were studied.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Medical-Surgical Intensive Care Unit, CHU Dupuytren, 2 Ave. Martin Luther King, 87042, Limoges Cedex, France. philippe.vignon@unilim.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon
authors.forename: Anthony
authors.initials: A
authors.lastname: Dugard
authors.forename: Julie
authors.initials: J
authors.lastname: Abraham
authors.forename: Dominique
authors.initials: D
authors.lastname: Belcour
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gondran
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pepino
authors.forename: Benoît
authors.initials: B
authors.lastname: Marin
authors.forename: Bruno
authors.initials: B
authors.lastname: François
authors.forename: Hervé
authors.initials: H
authors.lastname: Gastinne
mesh_terms: D002983:Clinical Competence; D016638:Critical Illness; D003479:Curriculum; D004452:Echocardiography / Q000295:instrumentation; D006801:Humans; D007318:Inservice Training; D007362:Intensive Care Units; D007396:Internship and Residency; D008875:Middle Aged; D010865:Pilot Projects; D019095:Point-of-Care Systems