Beaulieu Yanick
Hôpital Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.
Crit Care Med. 2007 May;35(5 Suppl):S144-9. doi: 10.1097/01.CCM.0000260682.62472.67.
Echocardiography in the critical care setting can provide crucial information about the patient's cardiac anatomy, ejection fraction, valvular function, and volume status. There is a need for more involvement by intensivists in performing focused echocardiographic studies as this modality has been well shown to improve patient care. Several factors limit the widespread use of this technology by intensivists that are noncardiologists. One of them is the lack of formal didactic and practical training programs in "goal-directed" echocardiography specifically oriented for the critical care specialist. Although it is clear that extensive training and experience are needed to perform and interpret a complete echocardiographic study, a growing body of literature demonstrates that noncardiology medical professionals can be trained to acquire and interpret echocardiographic imaging in a goal-directed or "focused" manner with an acceptable overall level of accuracy. Performance of such focused echocardiography by intensivists has been shown to provide new information not assessable by physical examination, and often leads to change in therapeutic management at the bedside. Echocardiography using the transthoracic approach is a noninvasive imaging modality and is of great value in the critical care setting because of its portability, widespread availability, and rapid diagnostic capability. Programs for intensivists should cover both the transthoracic and transesophageal approach. Focused training with the transthoracic approach should be offered to all intensivists, while training with the transesophageal approach should be offered to intensivists who desire more advanced training. This article will go over important issues regarding current and potential avenues for training of critical care physicians in performance of focused bedside echocardiography.
重症监护环境中的超声心动图检查能够提供有关患者心脏解剖结构、射血分数、瓣膜功能和容量状态的关键信息。重症医学专家需要更多地参与到有针对性的超声心动图检查中，因为这种检查方式已被充分证明可以改善患者护理。有几个因素限制了非心脏病专家的重症医学专家对这项技术的广泛应用。其中之一是缺乏专门为重症监护专家设计的“目标导向”超声心动图的正规理论和实践培训项目。虽然很明显，进行和解读完整的超声心动图检查需要广泛的培训和经验，但越来越多的文献表明，非心脏病医学专业人员可以接受培训，以目标导向或“有针对性”的方式获取和解读超声心动图图像，总体准确性可以接受。重症医学专家进行这种有针对性的超声心动图检查已被证明能提供体格检查无法获取的新信息，并且常常会导致床边治疗管理的改变。经胸超声心动图检查是一种无创成像方式，因其便携性、广泛可用性和快速诊断能力，在重症监护环境中具有重要价值。针对重症医学专家的培训项目应涵盖经胸和经食管两种检查方法。应向所有重症医学专家提供经胸检查方法的重点培训，而对于希望接受更高级培训的重症医学专家，则应提供经食管检查方法的培训。本文将探讨有关重症监护医生进行床边重点超声心动图检查的当前及潜在培训途径的重要问题。
