重症心脏超声培训后学员操作能力的自我评价

doi:10.24920/004174

Chinese Medical Sciences Journal ›› 2023, Vol. 38 ›› Issue (2): 125-129.doi: 10.24920/004174

重症心脏超声培训后学员操作能力的自我评价

何伟¹,曾学英²,张宏民^3,^*(),王小亭³,晁彦公⁴,重症超声研究组

¹首都医科大学北京同仁医院重症医学科，北京 100730
²四川大学华西公共卫生学院华西第四医院急诊和重症医学科，成都 610041
³中国医学科学院北京协和医学院，北京协和医院重症医学科，北京 100730
⁴清华大学第一附属医院重症医学科，北京 100016

收稿日期:2022-10-01 接受日期:2023-02-14 出版日期:2023-06-30 发布日期:2023-03-09

Self-Appraisal of Clinical Competence in Echocardiography of Chinese Intensivists Post Basic Echocardiography Training

Wei He¹,Xue-Ying Zeng²,Hong-Min Zhang^3,^*(),Xiao-Ting Wang³,Yan-Gong Chao⁴,Critical Care Ultrasound Study Group

¹Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
²Emergency Department and Intensive Care Unit, West China School of Public Health & West China Fourth Hospital, Sichuan University, Chengdu 610041, China
³Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
⁴Department of Critical Care Medicine, First Hospital of Tsinghua University, Beijing 100016, China

Received:2022-10-01 Accepted:2023-02-14 Published:2023-06-30 Online:2023-03-09
Contact: *ozohom@163.com

1. 附件.pdf(21KB)

摘要/Abstract

摘要：

目的调查参加初级重症心脏超声培训的重症医师的操作能力及其影响因素。

方法本研究通过网络调查的形式对2019~2020年参加初级重症心脏超声培训的重症医师进行随访。收集参加培训人员的一般资料，重症心脏超声操作频率，超声诊断对治疗决策的影响，以及超声操作能力的自我评价。采用Mann-Whitney分析研究影响疾病定性判断，下腔静脉内径测量，左室射血分数和左室流出道速度-时间积分测量能力的因素。

结果我们纳入了全国412家ICU的554名重症医师。在所有接受调查的医师中，33.4%（185/554）的医师认为重症心脏超声有10%~30%的可能误导治疗，仅6.1%（34/554）的医师认为重症心脏超声对治疗误导的可能性超过30%。在导师指导下完成超声检查和每周完成10次以上超声检查的医师，其对超声操作能力的自我评价更高（P < 0.05）。

结论完成基础重症心脏超声培训后，重症医师对操作能力的自我评价仍较低。今后的培训应加强质控，以改善培训效果。

关键词: 临床医师, 重症, 心脏超声, 培训

Abstract:

Objectives To learn the echocardiography skills of intensivists after receiving a basic critical care echocardiography training course, and investigate factors that may influence their performance.

Methods We completed a web-based questionnaire that assessed the skills in ultrasound scanning techniques of intensivists who took a training course on basic critical care echocardiography held in 2019 and 2020. Mann-Whitney test was used to analyze the factors which might affect their performance on image acquisition, recognizing clinical syndrome, and measuring the diameter of inferior vena cava, left ventricular ejection fraction and left ventricular outflow tract velocity-time integral.

Results We enrolled 554 physicians from 412 intensive care units across China. Among them, 185 (33.4%) reported that they had 10%-30% chance of being misled by critical care echocardiography when making therapeutic decision, and 34 (6.1%) reported that the chance was greater than 30%. Intensivists who performed echocardiography under the guidance of a mentor and finished ultrasound scanning more than 10 times per week reported significant higher scores in image acquisition, clinical syndrome recognition, and quantitative measurement of inferior vena cava diameter, left ventricular ejection fraction and left ventricular outflow tract velocity-time integral than those without mentor and performing echocardiography 10 times or less per week respectively (all P < 0.05).

Conclusion The skills in diagnostic medical echocardiography of Chinese intensivists after a basic echocardiographic training course remain low, and further quality assurance training program is clearly warranted.

Key words: physician, critical care, echocardiography, training

Wei He, Xue-Ying Zeng, Hong-Min Zhang, Xiao-Ting Wang, Yan-Gong Chao, Critical Care Ultrasound Study Group . Self-Appraisal of Clinical Competence in Echocardiography of Chinese Intensivists Post Basic Echocardiography Training[J].Chinese Medical Sciences Journal, 2023, 38(2): 125-129.

图/表 3

参考文献 20

1	McLean AS. Echocardiography in shock management. Crit Care 2016; 20:275. doi: 10.1186/s13054-016-1401-7. doi: 10.1186/s13054-016-1401-7
2	Sekiguchi H, Schenck LA, Horie R, et al. Critical care ultrasonography differentiates ARDS, pulmonary edema, and other causes in the early course of acute hypoxemic respiratory failure. Chest 2015; 148(4):912-8. doi: 10.1378/chest.15-0341. doi: S0012-3692(15)50279-1 pmid: 25996139
3	Vieillard-Baron A, Millington SJ, Sanfilippo F, et al. A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med 2019 ; 45(6):770-88. doi: 10.1007/s00134-019-05604-2. doi: 10.1007/s00134-019-05604-2
4	Kiefer JJ, Gold AK, Feinman JW, et al. Critical care and perioperative echocardiography certification: challenges ahead. J Cardiothorac Vasc Anesth 2021 ; 35(1):248-50. doi: 10.1053/j.jvca.2020.08.016. doi: 10.1053/j.jvca.2020.08.016
5	Wong A, Galarza L, Duska F. Critical care ultrasound: a systematic review of international training competencies and program. Crit Care Med 2019 ; 47(3):e256-e62. doi: 10.1097/CCM.0000000000003626. doi: 10.1097/CCM.0000000000003626
6	Heiberg J, El-Ansary D, Canty DJ, et al. Focused echocardiography: a systematic review of diagnostic and clinical decision-making in anaesthesia and critical care. Anesthesia 2016 ; 71(9):1091-100. doi: 10.1111/anae.13525. doi: 10.1111/anae.13525
7	Greenstein YY, Littauer R, Narasimhan M, et al. Effectiveness of a critical care ultrasonography course. Chest 2017 ; 151(1):34-40. doi: 10.1016/j.chest.2016.08.1465. doi: 10.1016/j.chest.2016.08.1465
8	Labbé V, Ederhy S, Pasquet B, 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(1):44. doi: 10.1186/s13613-016-0150-8. doi: 10.1186/s13613-016-0150-8
9	Zhang H, He W, Wang X, et al. Physicians’ ability to visually estimate left ventricular ejection fraction, right ventricular enlargement, and paradoxical septal motion after a 2-day focused cardiac ultrasound training course. J Cardiothorac Vasc Anesth 2019 ; 33(7):1912-8. doi: 10.1053/j.jvca.2018.10.019. doi: 10.1053/j.jvca.2018.10.019
10	Rajamani A, Miu M, Huang S, et al. Impact of critical care point-of-care ultrasound short-courses on trainee competence. Crit Care Med 2019 ; 47(9): e782-e4. doi: 10.1097/CCM.0000000000003867. doi: 10.1097/CCM.0000000000003867
11	Papolos A, Narula J, Bavishi C, et al. U.S. Hospital use of echocardiography: insights from the nationwide inpatient sample. J Am Coll Cardiol 2016 ; 67(5):502-11. doi: 10.1016/j.jacc.2015.10.090. doi: 10.1016/j.jacc.2015.10.090
12	Quiñones MA, Otto CM, Stoddard M, et al. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002 ; 15(2):167-84. doi: 10.1067/mje.2002.120202. doi: 10.1067/mje.2002.120202
13	Zieleskiewicz L, Muller L, Lakhal K, et al. Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study. Intensive Care Med 2015 ; 41(9):1638-47. doi: 10.1007/s00134-015-3952-5. doi: 10.1007/s00134-015-3952-5
14	Feissel M, Michard F, Faller JP, et al. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med 2004 ; 30(9):1834-7. doi: 10.1007/s00134-004-2233-5. doi: 10.1007/s00134-004-2233-5
15	Cholley B. Echocardiography in the intensive care unit: beyond “eyeballing”. A plea for the broader use of the aortic velocity-time integral measurement. Intensive Care Med 2019 ; 45(6):898-901. doi: 10.1007/s00134-019-05618-w. doi: 10.1007/s00134-019-05618-w
16	Price S, Nicol E, Gibson DG, et al. Echocardiography in the critically ill: current and potential roles. Intensive Care Med 2006 ; 32(1):48-59. doi: 10.1007/s00134-005-2834-7. doi: 10.1007/s00134-005-2834-7
17	Orde S, Slama M, Hilton A, et al. Pearls and pitfalls in comprehensive critical care echocardiography. Crit Care 2017 ; 21(1):279. doi: 10.1186/s13054-017-1866-z. doi: 10.1186/s13054-017-1866-z
18	Galarza L, Wong A, Malbrain M. The state of critical care ultrasound training in Europe: a survey of trainers and a comparison of available accreditation programmes. Anaesthesiol Intensive Ther 2017 ; 49(5):382-6. doi: 10.5603/AIT.a2017.0075. doi: 10.5603/AIT.a2017.0075
19	Arntfield R, Millington S, Ainsworth C, et al. Canadian recommendations for critical care ultrasound training and competency. Can Respir J 2014 ; 21(6):341-5. doi: 10.1155/2014/216591. doi: 10.1155/2014/216591
20	Flower L, Dempsey M, White A, et al. Training and accreditation pathways in critical care and perioperative echocardiography. J Cardiothorac Vasc Anesth 2021 ; 35(1):235-47. doi: 10.1053/j.jvca.2020.07.046. doi: 10.1053/j.jvca.2020.07.046

Items	Results
Age [yrs, median (IQR)]	37 (34, 41)
Male [n (%)]	288 (52.0)
Professional qualification [n (%)]
Attending	244 (44.0)
Fellow	276 (49.8)
Residents	34 (6.1)
Cases from a tertiary hospital [n (%)]	312 (56.3)
ICU working experience [yrs, median (IQR)]	9 (5, 12)
Echo exams per week [n (%)]
< 5	78 (14.1)
5-10	207 (37.4)
﹥ 10	269 (48.6)
Improvement in therapeutic decision making [n (%)]
< 30%	40 (7.2)
30%-50%	222 (40.1)
﹥ 50%	292 (52.7)
Misleading physicians to make therapeutic decision [n (%)]
< 10%	335 (60.5)
10%-30%	185 (33.4)
﹥ 30%	34 (6.1)
Mentor available [n (%)]	223 (40.3)

Groups		Image acquisition	Clinical syndrome	IVCD	LVEF	LVOT-VTI
Mentor available	No (n=331)	5 (4, 6)	6 (4, 7)	7 (6, 8)	6 (5, 7)	5 (4, 7)
	Yes (n=223)	6 (5, 7)	6 (5, 7)	7 (6, 8)	6 (5, 7)	6 (5, 7)
	Z value	-3.663	-2.631	-2.460	-2.621	-2.926
	P value	<0.001	0.009	0.014	0.009	0.003
Echo exams per week	≤ 10 (n=286)	5 (4, 6)	5 (4, 7)	7 (5, 8)	6 (4, 7)	5 (4, 6)
	> 10 (n=268)	6 (5, 7)	7 (5, 7)	7 (6, 8)	7 (6, 8)	6 (5, 7)
	Z value	-6.807	-8.058	-5.916	-7.061	-7.511
	P value	<0.001	<0.001	<0.001	<0.001	<0.001

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重症心脏超声培训后学员操作能力的自我评价

Self-Appraisal of Clinical Competence in Echocardiography of Chinese Intensivists Post Basic Echocardiography Training

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