%0 Journal Article
%T Therapeutic impact of basic critical care echocardiography performed by residents after limited training.
%A Goudelin M
%A Evrard B
%A Donisanu R
%A Gonzalez C
%A Truffy C
%A Orabona M
%A Galy A
%A Lapébie FX
%A Jamilloux Y
%A Vandeix E
%A Belcour D
%A Hodler C
%A Ramirez L
%A Gagnoud R
%A Chapellas C
%A Vignon P
%J Ann Intensive Care
%V 14
%N 1
%D 2024 Jul 29
%M 39073505
%F 10.318
%R 10.1186/s13613-024-01354-7
%X <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.