Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: a LUST trial sub-project.
Within the framework of the LUST trial (LUng water by Ultra-Sound guided Treatment to prevent death and cardiovascular events in high-risk end-stage renal disease patients), the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis Transplant Association established a central core lab aimed at training and certifying nephrologists and cardiologists participating in this trial. All participants were trained by an expert trainer with an entirely web-based programme. Thirty nephrologists and 14 cardiologists successfully completed the training. At the end of training, a set of 47 lung ultrasound (US) videos was provided to trainees who were asked to estimate the number of B-lines in each video. The intraclass correlation coefficient (ICC) for the whole series of 47 videos between each trainee and the expert trainer was high (average 0.81 ± 0.21) and >0.70 in all but five cases. After further training, the five underperforming trainees achieved satisfactory agreement with the expert trainer (average post-retraining ICC 0.74 ± 0.14). The Bland-Altman plot showed virtually no bias (difference between the mean 0.03) and strict 95% limits of agreement lines (-1.52 and 1.45 US B-lines). Only four cases overlapped but did not exceed the same limits. Likewise, the Spearman correlation coefficient applied to the same data series was very high (r = 0.979, P < 0.0001). Nephrologists and cardiologists can be effectively trained to measure lung congestion by an entirely web-based programme. This web-based training programme ensures high-quality standardization of US B-line measurements and represents a simple, costless and effective preparatory step for clinical trials targeting lung congestion.
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.
Luna
L
Gargani
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.
Rosa
R
Sicari
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.
Mauro
M
Raciti
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.
Luca
L
Serasini
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.
Mirko
M
Passera
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.|Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Cal. Unit.
Claudia
C
Torino
Department of Nephrology & Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
Krzysztof
K
Letachowicz
University Clinical Centre Maribor, Maribor, Slovenia.
Robert
R
Ekart
Saarland University Medical Centre, Homburg, Germany.
Danilo
D
Fliser
Dr. C.I. Parhon Hospital, and University of Medicine "Grigore T. Popa" Iasi, Romania.
Adrian
A
Covic
University Hospital of Ioannina, Ioannina, Greece.
Olga
O
Balafa
IASIO Hospital - General Clinic of Kallithea, Athens, Greece.
Aristeidis
A
Stavroulopoulos
Ambroise Pare University Hospital, APHP, Paris-Ile-de France-Ouest University (UVSQ), and INSERM U1018, 15 Boulogne Billancourt, France.|FCRIN INI-CRCT, Nancy, France.
Ziad A
ZA
Massy
Parma University Medical School, Parma, Italy.
Enrico
E
Fiaccadori
ASL Parma, Italy.
Alberto
A
Caiazza
C.T.M.R. Saint-Augustin, Bordeaux, France.
Thomas
T
Bachelet
Shaare Zedek Medical Center, Jerusalem, Israel.
Itzchak
I
Slotki
Shaare Zedek Medical Center, Jerusalem, Israel.
Linda
L
Shavit
Bellvitge University Hospital, Hospitalet, Barcelona, Spain.
Alberto
A
Martinez-Castelao
Centre d'Investigation Clinique Plurithématique - INSERM 1433 CHU de Nancy, University of Lorraine, Association Lorraine de Traitement de l'Insuffisance Rénale (ALTIR), Nancy, France.
Marie-Jeanne
MJ
Coudert-Krier
FCRIN INI-CRCT, Nancy, France.|Centre d'Investigation Clinique Plurithématique - INSERM 1433 CHU de Nancy, University of Lorraine, Association Lorraine de Traitement de l'Insuffisance Rénale (ALTIR), Nancy, France.
Patrick
P
Rossignol
Nephrology, Hannover Medical School, Hannover, Germany.
Thomas Daniel
TD
Kraemer
FCRIN INI-CRCT, Nancy, France.|University Hospital Strasbourg, Strasbourg, France.
Thierry
T
Hannedouche
ASL 12, Versilia Hospital, Viareggio, Italy.
Vincenzo
V
Panichi
Medical University of Silesia in Katowice, Katowice, Poland.
Andrzej
A
Wiecek
Ospedale A. Manzoni, Lecco, Italy.
Giuseppe
G
Pontoriero
Hippokration Hospital, Aristotle University of Thessaloniki, Greece.
Pantelis
P
Sarafidis
Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Cal. Unit.
Marian
M
Klinger
Department of Nephrology & Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
Radovan
R
Hojs
University Clinical Centre Maribor, Maribor, Slovenia.
Sarah
S
Seiler-Mußler
University Clinical Centre Maribor, Maribor, Slovenia.
Fabio
F
Lizzi
Saarland University Medical Centre, Homburg, Germany.
Mihai
M
Onofriescu
Dr. C.I. Parhon Hospital, and University of Medicine "Grigore T. Popa" Iasi, Romania.
Fotis
F
Zarzoulas
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.|Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Cal. Unit.
Rocco
R
Tripepi
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.|Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Cal. Unit.
Francesca
F
Mallamaci
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.|Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Cal. Unit.
Giovanni
G
Tripepi
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.
Eugenio
E
Picano
FCRIN INI-CRCT, Nancy, France.|Centre Hospitalier F.H. Manhès, Fleury-Merogis, France.
Gérard Michel
GM
London
Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1 56124 Pisa, Italy.|Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Cal. Unit.
Carmine
C
Zoccali
D000072096:Cardiologists / Q000193:education*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D003194:Computer-Assisted Instruction / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D020407:Internet; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D000072104:Nephrologists / Q000193:education*; D014463:Ultrasonography / Q000379:methods*
ESRD; US B-lines; lung congestion; lung ultrasound; pulmonary oedema