From the *Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; †Department of Intensive Care Medicine, Spitalzentrum Biel, Biel, Switzerland; ‡Department of Anesthesiology and Pain Therapy, Inselspital, Bern University Hospital, University of Bern, Switzerland; and §Clinical Trial Unit Bern, Department of Clinical Research, University of Bern, Bern, Switzerland.
Anesth Analg. 2017 Oct;125(4):1140-1148. doi: 10.1213/ANE.0000000000002351.
The aim of the study was to determine if training in transesophageal echocardiography (TEE) using a TEE simulator improves the ability of novice operators to perform and interpret a focused critical care TEE.
In this prospective, randomized, controlled study with blinded outcome assessment, 44 intensive care unit trainees were randomly assigned to a control group receiving 4 hours of lecture-based training only, or an intervention group which was additionally trained for 4 hours using a TEE simulator. After the training intervention, each participant performed 2 TEEs in intensive care unit patients which were evaluated by blinded assessors. The imaging quality of TEEs was measured using a predefined examination quality score ranging from 0 to 100 points. The correct quantification of pathologies and the interpretation of the TEEs were evaluated by blinded assessors using focused and comprehensive expert TEEs as comparators.
A total of 114 TEEs were assessed. The mean examination quality score was 55.9 (95% confidence interval [CI], 50.3-61.5) for TEEs of the control group, 75.6 (95% CI, 70.1-81.0) for TEEs of the intervention group, and 88.5 (95% CI, 79.3-97.7) for TEEs in the expert group. The multiple comparisons revealed significant differences between all groups (19.7 [95% CI, 12.8-26.6], P < .001 for intervention versus control; 32.6 [95% CI, 23.0-42.3], P < .001 for expert versus control; 12.9 [95% CI, 3.4-22.5], P = .008 for expert versus intervention). Substantial agreement of the quantification and interpretation ratings of basic TEEs by the intervention (86.7% for quantification and 97.1% for interpretation) or expert group (93.2% for quantification and 98.4% for interpretation) with blinded assessors was detected. The control groups TEEs agreed less (75.6% for quantification and 91.8% for interpretation).
Simulation-based TEE training improves the ability of novice operators to perform a focused critical care TEE in comparison to lecture-based education only. After 8 hours of simulator and lecture-based training, the majority of TEEs of novices are of sufficient quality for clinical use. Furthermore, a substantial skill level in correct quantification and interpretation of imaging is achieved.
本研究旨在确定经胸超声心动图（TEE）模拟器培训是否能提高新手操作人员进行和解读集中式重症监护 TEE 的能力。
这是一项前瞻性、随机、对照研究，采用盲法结局评估，将 44 名重症监护病房受训者随机分为对照组（仅接受 4 小时基于讲座的培训）或干预组（另外接受 4 小时 TEE 模拟器培训）。培训干预后，每位参与者在重症监护病房患者中进行 2 次 TEE，由盲法评估者进行评估。使用预设的检查质量评分（范围为 0 至 100 分）来测量 TEE 的成像质量。使用集中式和综合专家 TEE 作为对照，盲法评估者评估 TEE 的正确定量和解读。
共评估了 114 次 TEE。对照组 TEE 的平均检查质量评分为 55.9（95%置信区间 [CI]，50.3-61.5），干预组为 75.6（95% CI，70.1-81.0），专家组为 88.5（95% CI，79.3-97.7）。多组比较显示，所有组之间均存在显著差异（干预组与对照组相比为 19.7[95%CI，12.8-26.6]，P<.001；专家组与对照组相比为 32.6[95%CI，23.0-42.3]，P<.001；专家组与干预组相比为 12.9[95%CI，3.4-22.5]，P=.008）。干预组（定量为 86.7%，解读为 97.1%）或专家组（定量为 93.2%，解读为 98.4%）对基本 TEE 的定量和解读评分与盲法评估者的一致性很高。对照组的 TEE 一致性较低（定量为 75.6%，解读为 91.8%）。
与仅基于讲座的教育相比，基于模拟的 TEE 培训可提高新手操作人员进行集中式重症监护 TEE 的能力。经过 8 小时的模拟器和基于讲座的培训后，新手的 TEE 中有很大一部分质量足以用于临床使用。此外，还实现了在正确定量和解读成像方面的较高技能水平。
