The training session significantly improved the residents' compliance with guidelines and their performance of cricothyrotomy.

IntroductionTransthoracic echocardiography (TTE) is a useful tool for minimally invasive hemodynamic monitoring in the ICU. Dynamic indices (such as the inferior vena cava distensibility index (dIVC)) can be used to predict fluid responsiveness in mechanically ventilated patients. Although quantitative use of the dIVC has been validated, the routinely used qualitative (visual) approach had not been assessed before the present study.MethodsQualitative and quantitative assessments of the dIVC were compared in a prospective, observational study. After operators with differing levels in critical care echocardiography had derived a qualitative dIVC, the last (expert) operator performed a standard, numeric measurement of the dIVC (referred to as the quantitative dIVC). Two groups of patients were separated into two groups: group (dIVC < 18%) and group (dIVC ≥ 18%).ResultsIn total, 114 patients were assessed for inclusion, and 97 (63 men and 34 women) were included. The mean sensitivity and specificity values for qualitative assessment of the dIVC by an intensivist were 80.7% and 93.7%, respectively. A qualitative evaluation detected all quantitative dIVCs >40%. Most of the errors concerned quantitative dIVCs of between 15% and 30%. In the dIVC <18% group, two qualitative evaluation errors were noted for quantitative dIVCs of between 0 and 10%. The average of positive predictive values and negative predictive values for qualitative assessment of the dIVC by residents, intensivists and cardiologists were 83%, 83%, and 90%; and 92%, 94%, and 90%, respectively. The Fleiss kappa for all operators was estimated to be 0.68, corresponding to substantial agreement.ConclusionThe qualitative dIVC is a rather easy and reliable assessment for extreme numeric values. It has a gray zone between 15% and 30%. The highest and lowest limitations of the gray area are rather tedious to define.Despite reliability of the qualitative assessment when it comes to extreme to numerical values, the quantitative dIVC measurement must always be done within a hemodynamic assessment for intensive care patients. The qualitative approach can be easily integrated into a fast hemodynamic evaluation by using portable ultrasound scanner for out-of-hospital patients.

T he effectiveness of simulation is rarely evaluated. The impact of a short-training course on the ability of anesthesiology residents to comply with current difficult airway management guidelines was assessed. Twenty-seven third-year anesthesiology residents were evaluated on a simulator in a "can't intubate, can't ventilate" (CICV) scenario before the training (the pretest) and then randomly at 3, 6, or 12 months after training (the posttest). The scenario was constructed so that the resident was prompted to perform a cricothyrotomy. Adherence with airway management guidelines and the duration of the cricothyrotomy and technical quality were assessed as a checklist score (0-10) and a global rating scale (7-35). After training, all 27 residents complied with the airway management guidelines compared with 17 (63%) in the pretest (P < 0.005). In the pretest and the 3-, 6-, and 12-month posttests, the median (range) duration of cricothyrotomy was 117 seconds (70-184 seconds), 69 seconds (43-97 seconds), 52 seconds (43-76 seconds), and 62 seconds (43-74 seconds) versus the pretest (P < 0.0001). The median (range) checklist score was 3 (0-7), 8 (8-10), 9 (6-10) and 9 (4-10) versus the pretest (P < 0.0001). The median (range) global rating scale was 12 (7-22), 30 (20-35), 33 (23-35), and 31 (18-33) versus in the pretest (P < 0.0001). There were no marked differences between performance levels attained in the 3-, 6-, and 12-month posttests. The training session markedly improved the resident' compliance with guidelines and their performance of cricothyrotomy.

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