Goudelin Marine, Evrard Bruno, Donisanu Roxana, Gonzalez Céline, Truffy Christophe, Orabona Marie, Galy Antoine, Lapébie François-Xavier, Jamilloux Yvan, Vandeix Elodie, Belcour Dominique, Hodler Charles, Ramirez Lucie, Gagnoud Rémi, Chapellas Catherine, Vignon Philippe
Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France.
Inserm CIC1435, 87000, Limoges, France.
Ann Intensive Care. 2024 Jul 29;14(1):119. doi: 10.1186/s13613-024-01354-7.
The objective was to assess the agreement between therapeutic proposals derived from basic critical care echocardiography performed by novice operators in ultrasonography after a limited training (residents) and by experts considered as reference. Secondary objectives were to assess the agreement between operators' answers to simple clinical questions and the concordance between basic two-dimensional measurements.
This observational, prospective, single-center study was conducted over a 3-year period in a medical-surgical intensive care unit. Adult patients with acute circulatory and/or respiratory failure requiring a transthoracic echocardiography (TTE) examination were studied. In each patient, a TTE was performed by a resident novice in ultrasonography after a short training program and by an expert, independently but within 1 h and in random order. Each operator addressed standardized simple clinical questions and subsequently proposed a therapeutic strategy based on a predefined algorithm.
Residents performed an average of 33 TTE studies in 244 patients (156 men; age: 63 years [52-74]; SAPS2: 45 [34-59]; 182 (75%) mechanically ventilated). Agreement between the therapeutic proposals of residents and experienced operators was good-to-excellent. The concordance was excellent for suggesting fluid loading, inotrope or vasopressor support (all Kappa values > 0.80). Inter-observer agreement was only moderate when considering the indication of negative fluid balance (Kappa: 0.65; 95% CI 0.50-0.80), since residents proposed diuretics in 23 patients (9.5%) while their counterparts had the same suggestion in 35 patients (14.4%). Overall agreement of responses to simple clinical questions was also good-to-excellent. Intraclass correlation coefficient exceeded 0.75 for measurement of ventricular and inferior vena cava size.
A limited training program aiming at acquiring the basic level in critical care echocardiography enables ICU residents novice in ultrasonography to propose therapeutic interventions with a good-to-excellent agreement with experienced operators.
目的是评估经过有限培训的超声检查新手操作者（住院医师）进行的基础重症超声心动图得出的治疗建议与作为参考的专家得出的治疗建议之间的一致性。次要目的是评估操作者对简单临床问题的回答之间的一致性以及基础二维测量结果之间的一致性。
这项观察性、前瞻性、单中心研究在一家内科-外科重症监护病房进行了3年。研究了需要经胸超声心动图（TTE）检查的急性循环和/或呼吸衰竭成年患者。在每位患者中，一名经过短期培训计划的超声检查新手住院医师和一名专家独立进行TTE检查，但在1小时内且顺序随机。每位操作者回答标准化的简单临床问题，随后根据预定义算法提出治疗策略。
住院医师在244例患者中平均进行了33次TTE检查（156例男性；年龄：63岁[52 - 74岁]；简化急性生理学评分系统II（SAPS2）：45[34 - 59]；182例（75%）接受机械通气）。住院医师和经验丰富的操作者的治疗建议之间的一致性良好至优秀。在建议液体负荷、使用正性肌力药物或血管活性药物支持方面一致性极佳（所有Kappa值>0.80）。考虑负液体平衡的指征时，观察者间一致性仅为中等（Kappa：0.65；95%可信区间0.50 - 0.80），因为住院医师在23例患者（9.5%）中建议使用利尿剂，而经验丰富的操作者在35例患者（14.4%）中提出了相同建议。对简单临床问题的回答的总体一致性也良好至优秀。心室和下腔静脉大小测量的组内相关系数超过0.75。
旨在获得重症超声心动图基础水平的有限培训计划使超声检查新手的重症监护病房住院医师能够提出与经验丰富的操作者一致性良好至优秀的治疗干预措施。
