Makaryus Amgad N, Zubrow Michael E, Gillam Linda D, Michelakis Nickolaos, Phillips Lawrence, Ahmed Safi, Friedman David, Sison Cristina, Kort Smadar, Rosman David, Mangion Judy R
Division of Cardiology at North Shore University Hospital, New York University School of Medicine, Manhasset, New York, USA.
J Am Soc Echocardiogr. 2005 May;18(5):475-80. doi: 10.1016/j.echo.2004.10.004.
Bedside portable echocardiography in the intensive care department (ICU) is technically difficult, but crucial for directing patient care. Prior studies have shown contrast echocardiography (CE) in the ICU clarifies left ventricular wall motion when performed by experienced sonographers (ESO). However, in most hospitals, ESO are unavailable around the clock, and less experienced cardiovascular fellows or trainees may be asked to perform these examinations.
Transthoracic echocardiograms were retrospectively evaluated by level III trained echocardiographers for 213 patients in the ICU. Most were performed to assess left ventricular function (65% or 139 of 213) and were scanned by cardiology fellows (70% or 149 of 213) with less than 3 months echocardiography experience. Contrast agent was used in 29% (62 of 213) of all patients.
The conversion of suboptimal or diagnostically inadequate apical 4- and 2-chamber views to diagnostically adequate with contrast was statistically significant when performed by both cardiology fellows and ESO (Fischer exact test, P < .0002).
CE is effective in improving the diagnostic yield of transthoracic echocardiographic ICU studies performed by both novice sonographers and ESO. Using cardiology fellows to perform CE in this setting can be appropriate, particularly in after-hour situations, when ESO are not always available and the clinical question is left ventricular function. Results also suggest cardiology fellows can easily learn CE.
重症监护病房（ICU）中的床旁便携式超声心动图检查技术难度较大，但对指导患者护理至关重要。先前的研究表明，在ICU中，由经验丰富的超声检查医师（ESO）进行的对比超声心动图（CE）可使左心室壁运动更加清晰。然而，在大多数医院中，ESO并非随时可用，可能会要求经验较少的心血管专科住院医师或实习生进行这些检查。
由经过III级培训的超声心动图检查医师对ICU中的213例患者的经胸超声心动图进行回顾性评估。大多数检查是为了评估左心室功能（213例中的65%或139例），由超声心动图经验少于3个月的心脏病专科住院医师（213例中的70%或149例）进行扫描。29%（213例中的62例）的患者使用了造影剂。
心脏病专科住院医师和ESO在进行检查时，使用造影剂将欠佳或诊断不充分的心尖四腔和两腔视图转换为诊断充分的视图，差异具有统计学意义（Fisher精确检验，P <.0002）。
CE可有效提高由新手超声检查医师和ESO进行的ICU经胸超声心动图检查的诊断率。在这种情况下，让心脏病专科住院医师进行CE是合适的，特别是在非工作时间，此时ESO并不总是可用，而临床问题是左心室功能。结果还表明，心脏病专科住院医师可以轻松学会CE。
