Servizio di Anestesia e Rianimazione 1, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
Cardiac Critical Care, King Abdulaziz Medical City, Ministry of National Guard Health, Riyadh, Saudi Arabia.
J Am Soc Echocardiogr. 2014 Jul;27(7):683.e1-683.e33. doi: 10.1016/j.echo.2014.05.001.
Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use.
The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method.
During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients.
This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.
聚焦式心脏超声（FoCUS）是一种简化的、由临床医生执行的超声心动图应用，在急诊和危重病医学中应用迅速扩大。由经过适当培训的临床医生（通常不是心脏病专家）进行 FoCUS，可以确定在时间敏感的临床决策中关键情况下所需的基本信息。因此需要对其使用进行基于质量证据的审查和临床推荐。
世界危重症超声互动网络对 FoCUS 进行了国际、多学科、基于证据、方法严谨的共识制定过程。来自 16 个国家的 33 名专家参与其中。进行了系统的多数据库、双轨文献检索（1980 年 1 月至 2013 年 9 月）。采用推荐分级、评估、制定与评价方法（Grading of Recommendation, Assessment, Development and Evaluation，GRADE）来确定现有证据的质量，并随后制定推荐意见。通过 RAND 适宜性方法收集和分析循证小组判断和共识。
在四次会议（新德里、米兰、波士顿和巴塞罗那）中，详细阐述和讨论了 108 条陈述。使用改良 Delphi 技术进行了两轮面对面辩论。有 10 条陈述存在分歧。对两条陈述提出了弱或有条件的建议，对 96 条陈述提出了强或很强的建议。这些建议描绘了 FoCUS 的性质、应用、技术、潜在益处、临床整合、教育和认证原则，既适用于成人也适用于儿科患者。
本文介绍了首次国际 FoCUS 会议的结果。首次全面提出基于证据的临床推荐意见，全面阐述了这一分支的床旁超声技术，为 FoCUS 在全球不同临床环境中应用提供了标准化的框架。
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