Intensive Care Unit, Section Thorax-Vascular Diseases-Abdomen-Metabolism, University Hospital Ambroise Paré, 9 Avenue Charles de Gaulle, 92104 Boulogne, France.
Intensive Care Med. 2013 Jun;39(6):1019-24. doi: 10.1007/s00134-013-2838-7. Epub 2013 Jan 24.
To determine the minimum number of supervised transesophageal echocardiography (TEE) that intensivists should perform to reach competence in performing and interpreting a comprehensive hemodynamic assessment in ventilated intensive care unit patients.
Prospective and multicentric study. Skills of 41 intensivists (trainees) with no (level 0) or little (level 1) experience in echocardiography was evaluated over a 6-month period, using a previously validated skills assessment score (/40 points). Trainees were evaluated at 1 (M1), 3 (M3) and 6 months (M6) by their tutor while performing 2 TEE examinations in ventilated patients. Competence was a priori defined by a skills assessment score >35/40 points.
No difference in the score was observed between level 0 and level 1, except at M1 (22.2 ± 6.2 vs. 25.9 ± 4.4 points, p = 0.03). After 6 months, trainees performed a mean of 31 ± 9 supervised TEE. The score gradually increased from M1 to M6 (24 ± 6, 32 ± 3, and 35 ± 3 points, p < 0.001), regardless of trainees' initial level. A correlation was found between the number of supervised TEE and the skills assessment score (r (2) = 0.60; p < 0.001). The number of supervised TEE examinations which best predicted a score >35/40 points was 25, with a sensitivity of 81 % and a specificity of 93 % (area under the ROC curve: 0.91 ± 0.04). A number of 31 supervised TEE examinations predicted a score >35/40 points with a specificity close to 100 %.
The performance of at least 31 supervised examinations over 6 months is required to reach competence in TEE driven hemodynamic evaluation of ventilated patient.
确定重症监护医师在进行有创超声心动图（TEE）检查时，为达到对机械通气患者进行全面血流动力学评估的胜任能力，应完成的最低监督检查次数。
前瞻性多中心研究。使用先前验证的技能评估评分（/40 分），评估 41 名无（0 级）或很少（1 级）超声心动图经验的重症监护医师（学员）的技能，为期 6 个月。在 6 个月的时间里，学员在为 2 名机械通气患者进行 2 次 TEE 检查时，由导师对其进行评估。在 1 个月（M1）、3 个月（M3）和 6 个月（M6）评估学员的能力，以预先确定技能评估评分>35/40 分为胜任。
在 M1 时，0 级和 1 级之间的评分没有差异（22.2 ± 6.2 与 25.9 ± 4.4 分，p = 0.03），但在 M1 时除外。6 个月后，学员平均完成 31 ± 9 次监督 TEE。无论学员的初始水平如何，评分均从 M1 逐渐增加到 M6（24 ± 6、32 ± 3 和 35 ± 3 分，p<0.001）。监督 TEE 的次数与技能评估评分之间存在相关性（r（2）= 0.60；p<0.001）。预测评分>35/40 分的最佳监督 TEE 检查次数为 25，其敏感性为 81%，特异性为 93%（ROC 曲线下面积：0.91 ± 0.04）。31 次监督 TEE 检查可预测评分>35/40 分，特异性接近 100%。
为达到对机械通气患者进行 TEE 驱动血流动力学评估的胜任能力，需要在 6 个月内完成至少 31 次监督检查。
