focused transthoracic echocardiography, intensivists and Doppler,Competence of intensivists
Citation Information :
Senthilnathan M, Kundra P, Mishra S, Velayudhan S, Pillai A. Competence of intensivists in focused transthoracic echocardiography in intensive care unit: A prospective observational study. Indian J Crit Care Med 2018; 22 (5):340-345.
Objectives: Focused transthoracic echocardiography (fTTE) in critical care can be used to assess patient\'s volume status, ventricular contractility, right ventricle chamber size, and valvular abnormalities. The objective of the study was to assess the competency of intensivists in performing fTTE in Intensive Care Unit (ICU) patients after a brief training course by cardiologist using a specific ECHO protocol.
Methods: One hundred and four patients in ICU were recruited for this prospective observational study over a period of 12 months. Intensivists were trained for 60 h (2 h/day for 30 days). Intensivists performed fTTE in 82 ICU patients using a specific ECHO protocol developed in consensus with cardiologists. Each patient was assessed by an intensivist and two blinded cardiologists. At the end of the study period, the competency of intensivists was compared with two cardiologists and analyzed using intraclass correlation coefficient (ICC).
Results: There were excellent agreement between intensivists and cardiologists in terms of measuring ejection fraction (ICC estimate was 0.973–0.987), valvular function (ICC estimate for mitral valve was 0.940–0.972; ICC estimate for aortic valve was 0.872–0.940), and ICC estimate for pulmonary hypertension was 0.929–0.967. Good reliability has been found for the assessment of volume status with inferior vena cava diameter (ICC estimate for assessing hypovolemia was 0.790–0.902).
Conclusion: Intensivists with requisite training in TTE were able to perform focused echocardiography with comparable accuracy to that of cardiologists. Further studies are required to elucidate the therapeutic implications of fTTE performed by the intensivists.
Armstrong WF, Ryan T, Feigenbaum H. Feigenbaum's Echocardiography. Philadelphia: Lippincott Williams & Wilkins; 2010.
Oh JK, Seward JB, Tajik AJ. The Echo Manual. Philadelphia: Lippincott Williams & Wilkins; 2006.
Moore CL, Rose GA, Tayal VS, Sullivan DM, Arrowood JA, Kline JA, et al. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med 2002;9:186-93.
Stanko LK, Jacobsohn E, Tam JW, De Wet CJ, Avidan M. Transthoracic echocardiography: Impact on diagnosis and management in tertiary care Intensive Care Units. Anaesth Intensive Care 2005;33:492-6.
Canty DJ, Royse CF. Audit of anaesthetist-performed echocardiography on perioperative management decisions for non-cardiac surgery. Br J Anaesth 2009;103:352-8.
Ilyas A, Ishtiaq W, Assad S, Ghazanfar H, Mansoor S, Haris M, et al. Correlation of IVC diameter and collapsibility index with central venous pressure in the assessment of intravascular volume in critically ill patients. Cureus 2017;9:e1025.
Çelebi Yamanoğlu NG, Yamanoğlu A, Parlak İ, Pınar P, Tosun A, Erkuran B, et al. The role of inferior vena cava diameter in volume status monitoring; the best sonographic measurement method? Am J Emerg Med 2015;33:433-8.
Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, et al. Reappraisal of the use of inferior vena cava for estimating right atrial pressure. J Am Soc Echocardiogr 2007;20:857-61.
Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016;15:155-63.
Bland JM, Altman DG. Applying the right statistics: Analyses of measurement studies. Ultrasound Obstet Gynecol 2003;22:85-93.
Royse CF, Haji DL, Faris JG, Veltman MG, Kumar A, Royse AG, et al. Evaluation of the interpretative skills of participants of a limited transthoracic echocardiography training course (H.A.R.T.scan course). Anaesth Intensive Care 2012;40:498-504.
Randazzo MR, Snoey ER, Levitt MA, Binder K. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med 2003;10:973-7.
Mehta Y, Arora D. Newer methods of cardiac output monitoring. World J Cardiol 2014;6:1022-9.
Drummond KE, Murphy E. Minimally invasive cardiac output monitors. Contin Educ Anaesth Crit Care Pain 2012;12:5-10.
Lee AJ, Cohn JH, Ranasinghe JS. Cardiac output assessed by invasive and minimally invasive techniques. Anesthesiol Res Pract 2011;2011:475151.
Lebeau R, Potter BJ, Sas G, Moustafa S, Di Lorenzo M, Soulieres V, et al. Performance of a simplified wall motion score index method for noncardiologists to assess left ventricular ejection fraction. Int Sch Res Not 2012;2012:1-5. Available from: https://www.hindawi.com/journals/isrn/2012/309470/. [Last accessed on 2017 Sep 19].
Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3033-69.
Lancellotti P, Tribouilloy C, Hagendorff A, Moura L, Popescu BA, Agricola E, et al. European association of echocardiography recommendations for the assessment of valvular regurgitation. Part 1: Aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr 2010;11:223-44.
Sanfilippo F, Santonocito C, Burgio G, Arcadipane A. The importance of diastolic dysfunction in the development of weaning-induced pulmonary oedema. Crit Care 2017;21:29.
Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S, et al. Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J 2012;33:895-903.
Labbé V, Ederhy S, Pasquet B, Miguel-Montanes R, Rafat C, Hajage D, et al. Can we improve transthoracic echocardiography training in non-cardiologist residents? Experience of two training programs in the Intensive Care Unit. Ann Intensive Care 2016;6:44.
Cherpanath TG, Geerts BF, Lagrand WK, Schultz MJ, Groeneveld AB. Basic concepts of fluid responsiveness. Neth Heart J 2013;21:530-6.
Safdar N, O'Horo JC, Maki DG. Arterial catheter-related bloodstream infection: Incidence, pathogenesis, risk factors and prevention. J Hosp Infect 2013;85:189-95.
Kornbau C, Lee KC, Hughes GD, Firstenberg MS. Central line complications. Int J Crit Illn Inj Sci 2015;5:170-8.
El-Husseini W, Pravečková A, Kočková R, Marek T, Frídl P, Kautzner J. Pericardiocentesis guided by echocardiography performed in echocardiography laboratory – Safety profile of the single center prospective registry. Cor Vasa 2015;57:e239-44.