Imanishi Junichi, Iwasaki Masamichi, Ujiro Sae, Nakano Takahito, Yamashita Tomonori, Eto Hiroaki, Takemoto Makoto, Fujimoto Wataru, Kuroda Koji, Yamashita Soichiro, Todoroki Takahumi, Okuda Masanori
Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, Sumoto, Japan.
Department of Cardiology, Hyogo Prefectural Awaji Medicine Center, Sumoto, Japan.
Int J Cardiol. 2024 Jan 15;395:131446. doi: 10.1016/j.ijcard.2023.131446. Epub 2023 Oct 14.
The popularity of B-line-guided congestion assessment by lung ultrasound (LUS) has been increasing. However, the ability of novice residents to detect residual congestion with B-line-guided assessment by LUS after decongestion treatment is poorly understood. In this study, we investigated whether novice residents (no prior echocardiography experience) can acquire the skills for B-line-guided residual congestion assessment and whether the range of variation in assessment is acceptable in actual clinical use.
The study included 30 postgraduate first-year novice residents and an expert. The residents underwent training for LUS. At the end of the training session, a set of 15 LUS videos was provided to the residents, and they were asked to estimate the number of B-lines in each video. When the residents' answers greatly differed from the correct answer, we provided feedback to raise awareness of the discrepancies. After the training session, the residents performed residual congestion assessment by LUS after decongestion treatment in patients hospitalized with acute heart failure. The residents identified residual congestion in 57% of the patients. The sensitivity and specificity to identify residual congestion by the residents were 90% and 100%, respectively. The inter-operator agreement between the residents and the expert was substantial (κ = 0.86). The Spearman rank correlation coefficient for the B-lines between the expert and each resident was very high at 0.916 (P < 0.0001).
After a brief lecture, novice residents can achieve proficiency in quantifying B-lines on LUS and can reliably identify residual congestion on LUS.
通过肺部超声（LUS）进行B线引导的充血评估越来越受欢迎。然而，对于新手住院医师在充血治疗后通过LUS的B线引导评估来检测残余充血的能力，我们了解得还很少。在本研究中，我们调查了新手住院医师（无超声心动图经验）是否能够掌握B线引导的残余充血评估技能，以及在实际临床应用中评估的变异范围是否可接受。
本研究纳入了30名一年级新手住院医师和一名专家。住院医师接受了LUS培训。在培训课程结束时，向住院医师提供了一组15个LUS视频，并要求他们估计每个视频中的B线数量。当住院医师的答案与正确答案差异很大时，我们提供反馈以提高对差异的认识。培训课程结束后，住院医师对急性心力衰竭住院患者进行充血治疗后的残余充血进行LUS评估。住院医师在57%的患者中识别出残余充血。住院医师识别残余充血的敏感性和特异性分别为90%和100%。住院医师与专家之间的操作者间一致性较高（κ = 0.86）。专家与每位住院医师之间B线的Spearman等级相关系数非常高，为0.916（P < 0.0001）。
经过简短的讲座，新手住院医师可以熟练掌握LUS上B线的量化，并能可靠地识别LUS上的残余充血。
