title: Focused cardiac ultrasound: a training course for pediatric intensivists and emergency physicians.
abstract: BACKGROUND
  Focused echocardiographic examinations performed by intensivists and emergency room physicians can be a valuable tool for diagnosing and managing the hemodynamic status of critically ill children. The aim of this study was to evaluate the learning curve achieved using a theoretical and practical training program designed to enable pediatric intensivists and emergency physicians to conduct targeted echocardiograms.
  
  
  METHODS
  Theoretical and practical training sessions were conducted with 16 pediatric intensivist/emergency room physicians. The program included qualitative analyses of the left ventricular (LV) and right ventricular (RV) functions, evaluation of pericardial effusion/cardiac tamponade and valvular regurgitation and measurements of the distensibility index of the inferior vena cava (dIVC), ejection fraction (EF) and cardiac index (CI). The practical training sessions were conducted in the intensive care unit; each student performed 24 echocardiograms. The students in training were evaluated in a practical manner, and the results were compared with the corresponding examinations performed by experienced echocardiographers. The evaluations occurred after 8, 16 and 24 practical examinations.
  
  
  RESULTS
  The concordance rates between the students and echocardiographers in the subjective analysis of the LV function were 81.3% at the first evaluation, 96.9% at the second evaluation and 100% at the third evaluation (p < 0.001). For the dIVC, we observed a concordance of 46.7% at the first evaluation, 90.3% at the second evaluation and 87.5% at the third evaluation (p = 0.004). The means of the differences between the students' and echocardiographers' measurements of the EF and CI were 7% and 0.56 L/min/m2, respectively, after the third stage of training.
  
  
  CONCLUSIONS
  The proposed training was demonstrated to be sufficient for enabling pediatric physicians to analyze subjective LV function and to measure dIVC, EF and CI. This training course should facilitate the design of other echocardiography training courses that could be implemented in medical residency programs to improve these physicians' technical skills and the care of critically ill patients.
authors: Pediatric Intensive Care - Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University, Rua do Carreiro de Pedra 111 apto 152C, Jd, Caravelas, CEP 04728-020 São Paulo, Brazil. heloisaagaspar@uol.com.br.
authors: Heloisa A
authors: HA
authors: Gaspar
authors: Samira S
authors: SS
authors: Morhy
authors: Alessandro C
authors: AC
authors: Lianza
authors: Werther B
authors: WB
authors: de Carvalho
authors: Jose L
authors: JL
authors: Andrade
authors: Rogério R
authors: RR
authors: do Prado
authors: Cláudio
authors: C
authors: Schvartsman
authors: Artur F
authors: AF
authors: Delgado
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007396:Internship and Residency / Q000379:methods; D008297:Male; D010372:Pediatrics / Q000193:education*; D016277:Ventricular Function, Left