Focused Transthoracic Echocardiography During Critical Care Medicine Training

Abstract

e179Objectives: We designed and implemented a focused transthoracic echocardiography curriculum for critical care medicine fellows participating in 1-and 2-year training programs. We quantitatively evaluated their proficiency in focused transthoracic echocardiography. Design: Prospective study evaluating curriculum implementation and objective assessment of focused transthoracic echocardiography proficiency. Setting: Medical and surgical ICUs at an academic teaching hospital. Simulation laboratory. Subjects: Eighteen critical care medicine fellows. Interventions: Training in focused transthoracic echocardiography followed by proficiency testing. Measurements and Main Results: We assessed the ability of critical care medicine fellows to obtain and interpret focused transthoracic echocardiography images from critically ill patients and a from transthoracic echocardiography simulator. Using a cognitive examination test, we also evaluated each fellow's knowledge with regard to focused transthoracic echocardiography and each fellow's ability to interpret prerecorded focused transthoracic echocardiography images. After training, critical care medicine fellows were able to rapidly obtain five essential focused transthoracic echocardiography views: parasternal long axis, parasternal short axis, apical four chamber, subcostal four chamber, and subcostal inferior vena cava. Fellows were also able to expeditiously identify four important abnormalities: asystole, left ventricular dysfunction, right ventricular dilation and dysfunction, and a large pericardial effusion.Conclusions: A focused transthoracic echocardiography curriculum that includes quantitative measures of proficiency can be integrated into critical care medicine fellowship training programs. (Crit Care Med 2013; 41:e179-e181)

Cardiovascular Critical Care

“…Bedside echocardiography is a lowrisk, portable, and noninvasive tool that has been previously shown to assist critical care practitioners in the management of ICU patients (6,7). Several investigators, in fact, have developed and validated training platforms for improving TTE aptitude within critical care fellowships (13,14). We suggest that collaborative didactic and hands-on training,…”

The utility of remote supervision with feedback as a method to deliver high-volume critical care ultrasound training

“…First, it uses offline, digital supervision more extensively than other programs, and it has a higher volume of examinations [13,14]. Second, its multiorgan scope is distinct from previously reported CCUS curricula, which have been limited to a cardiac focus [14][15][16][17]. Finally, our curriculum provides supervision by an intensivist with CCUS expertise and uses globally endorsed competency and training statements specific to critical care medicine [1,2].…”

Echocardiography: the transition from master of the craft to admiral of the fleet: Table 1

“…We could use tools to ensure patients with abnormal findings on echocardiography also receive formal complete studies and are referred for appropriate sub-specialty care. We could implement standardised approaches to training and competence assessment, using both traditional approaches and high-level simulation technology to ensure each practitioner has mastered skills 8 9. Similar approaches could be used for periodic updating of skills for acquisition and interpretation of ultrasound data.…”