부산대학교 도서관

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Transthoracic ultrasound may be clinically useful, but training is not standardized, and it remains unclear when naïve trainees have sufficient competency to perform exams unsupervised WHAT THIS ARTICLE TELLS US THAT IS NEW: A multicenter, international study was conducted in 10 intensive care units among residents and staff in anesthesiology, critical care, emergency medicine, and internal medicine who underwent supervised training, to determine the number of exams required to achieve basic competenceAfter 25 supervised examinations, 80% of lung regions were adequately classified by traineesUltrasound exam average duration was 8 to 10 min in experts and decreased from 19 (after 5 exams) to 12 min (after 25 exams) in trainees BACKGROUND:: Lung ultrasound is increasingly used in critically ill patients as an alternative to bedside chest radiography, but the best training method remains uncertain. This study describes a training curriculum allowing trainees to acquire basic competence. METHODS:: This multicenter, prospective, and educational study was conducted in 10 Intensive Care Units in Brazil, China, France and Uruguay. One hundred residents, respiratory therapists, and critical care physicians without expertise in transthoracic ultrasound (trainees) were trained by 18 experts. The main study objective was to determine the number of supervised exams required to get the basic competence, defined as the trainees’ ability to adequately classify lung regions with normal aeration, interstitial–alveolar syndrome, and lung consolidation. An initial 2-h video lecture provided the rationale for image formation and described the ultrasound patterns commonly observed in critically ill and emergency patients. Each trainee performed 25 bedside ultrasound examinations supervised by an expert. The progression in competence was assessed every five supervised examinations. In a new patient, 12 pulmonary regions were independently classified by the trainee and the expert. RESULTS:: Progression in competence was derived from the analysis of 7,330 lung regions in 2,562 critically ill and emergency patients. After 25 supervised examinations, 80% of lung regions were adequately classified by trainees. The ultrasound examination mean duration was 8 to 10 min in experts and decreased from 19 to 12 min in trainees (after 5 vs. 25 supervised examinations). The median training duration was 52 (42, 82) days. CONCLUSIONS:: A training curriculum including 25 transthoracic ultrasound examinations supervised by an expert provides the basic skills for diagnosing normal lung aeration, interstitial–alveolar syndrome, and consolidation in emergency and critically ill patients.