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. 2018 May;22(5):340-345.
doi: 10.4103/ijccm.IJCCM_401_17.

Competence of Intensivists in Focused Transthoracic Echocardiography in Intensive Care Unit: A Prospective Observational Study

Muthapillai Senthilnathan  1 , Pankaj Kundra  1 , Sandeep Kumar Mishra  1 , Savitri Velayudhan  1 , Ajith Ananthakrishna Pillai  2
Affiliations

Competence of Intensivists in Focused Transthoracic Echocardiography in Intensive Care Unit: A Prospective Observational Study

Muthapillai Senthilnathan et al. Indian J Crit Care Med. 2018 May.

Abstract

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.

Keywords: Competence of intensivists; focused transthoracic echocardiography; intensivists and Doppler.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
STROBE diagram for various phases of the study (STROBE: Strengthening the reporting of observational studies in epidemiology)
Figure 2
Figure 2
Bland–Altman plot for agreement between cardiologist 1 and cardiologist 2 in measuring ejection fraction
Figure 3
Figure 3
Bland–Altman plot for agreement between cardiologist 1 and intensivist in measuring ejection fraction
Figure 4
Figure 4
Bland–Altman plot for agreement between cardiologist 2 and intensivist in measuring ejection fraction
See this image and copyright information in PMC

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