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Focused cardiac ultrasound: a training course for pediatric intensivists and emergency physicians.

Gaspar HA, Morhy SS, Lianza AC, de Carvalho WB, Andrade JL, do Prado RR, Schvartsman C, Delgado AF - BMC Med Educ (2014)

Bottom Line: The students in training were evaluated in a practical manner, and the results were compared with the corresponding examinations performed by experienced echocardiographers.The means of the differences between the students' and echocardiographers' measurements of the EF and CI were 7% and 0.56 L/min/m2, respectively, after the third stage of training.The proposed training was demonstrated to be sufficient for enabling pediatric physicians to analyze subjective LV function and to measure dIVC, EF and CI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pediatric Intensive Care - Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University, Rua do Carreiro de Pedra 111 apto 152C, Jd, Caravelas, CEP 04728-020 São Paulo, Brazil. heloisaagaspar@uol.com.br.

ABSTRACT

Background: Focused echocardiographic examinations performed by intensivists and emergency room physicians can be a valuable tool for diagnosing and managing the hemodynamic status of critically ill children. The aim of this study was to evaluate the learning curve achieved using a theoretical and practical training program designed to enable pediatric intensivists and emergency physicians to conduct targeted echocardiograms.

Methods: Theoretical and practical training sessions were conducted with 16 pediatric intensivist/emergency room physicians. The program included qualitative analyses of the left ventricular (LV) and right ventricular (RV) functions, evaluation of pericardial effusion/cardiac tamponade and valvular regurgitation and measurements of the distensibility index of the inferior vena cava (dIVC), ejection fraction (EF) and cardiac index (CI). The practical training sessions were conducted in the intensive care unit; each student performed 24 echocardiograms. The students in training were evaluated in a practical manner, and the results were compared with the corresponding examinations performed by experienced echocardiographers. The evaluations occurred after 8, 16 and 24 practical examinations.

Results: The concordance rates between the students and echocardiographers in the subjective analysis of the LV function were 81.3% at the first evaluation, 96.9% at the second evaluation and 100% at the third evaluation (p < 0.001). For the dIVC, we observed a concordance of 46.7% at the first evaluation, 90.3% at the second evaluation and 87.5% at the third evaluation (p = 0.004). The means of the differences between the students' and echocardiographers' measurements of the EF and CI were 7% and 0.56 L/min/m2, respectively, after the third stage of training.

Conclusions: The proposed training was demonstrated to be sufficient for enabling pediatric physicians to analyze subjective LV function and to measure dIVC, EF and CI. This training course should facilitate the design of other echocardiography training courses that could be implemented in medical residency programs to improve these physicians' technical skills and the care of critically ill patients.

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Related in: MedlinePlus

Measurement of the ejection fraction using M-mode in the parasternal long-axis view. The LV end-diastolic internal dimensional (EDd) is measured at the largest dimension, and the LV end-systolic internal dimensional (ESd) is measured at the smallest dimension. RV, right ventricle.
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Figure 2: Measurement of the ejection fraction using M-mode in the parasternal long-axis view. The LV end-diastolic internal dimensional (EDd) is measured at the largest dimension, and the LV end-systolic internal dimensional (ESd) is measured at the smallest dimension. RV, right ventricle.

Mentions: The LV function, assessed both qualitatively and quantitatively, was graded and classified subjectively through visual evaluation using two-dimensional images as follows: 0 - normal (EF greater than 55%), 1 - slight dysfunction (EF between 40% and 55%), 2 - moderate dysfunction (EF between 30% and 40%) and 3 - severe dysfunction (EF less than 30%). To calculate the EF, end-systolic and end-diastolic LV internal diameters were measured by M-mode using the inner edge technique at the level of the mitral leaflet tips in the parasternal long-axis view (Figure 2). The RV function was assessed only qualitatively and graded subjectively by two-dimensional mode using the same classification described for LV function.


Focused cardiac ultrasound: a training course for pediatric intensivists and emergency physicians.

Gaspar HA, Morhy SS, Lianza AC, de Carvalho WB, Andrade JL, do Prado RR, Schvartsman C, Delgado AF - BMC Med Educ (2014)

Measurement of the ejection fraction using M-mode in the parasternal long-axis view. The LV end-diastolic internal dimensional (EDd) is measured at the largest dimension, and the LV end-systolic internal dimensional (ESd) is measured at the smallest dimension. RV, right ventricle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3926333&req=5

Figure 2: Measurement of the ejection fraction using M-mode in the parasternal long-axis view. The LV end-diastolic internal dimensional (EDd) is measured at the largest dimension, and the LV end-systolic internal dimensional (ESd) is measured at the smallest dimension. RV, right ventricle.
Mentions: The LV function, assessed both qualitatively and quantitatively, was graded and classified subjectively through visual evaluation using two-dimensional images as follows: 0 - normal (EF greater than 55%), 1 - slight dysfunction (EF between 40% and 55%), 2 - moderate dysfunction (EF between 30% and 40%) and 3 - severe dysfunction (EF less than 30%). To calculate the EF, end-systolic and end-diastolic LV internal diameters were measured by M-mode using the inner edge technique at the level of the mitral leaflet tips in the parasternal long-axis view (Figure 2). The RV function was assessed only qualitatively and graded subjectively by two-dimensional mode using the same classification described for LV function.

Bottom Line: The students in training were evaluated in a practical manner, and the results were compared with the corresponding examinations performed by experienced echocardiographers.The means of the differences between the students' and echocardiographers' measurements of the EF and CI were 7% and 0.56 L/min/m2, respectively, after the third stage of training.The proposed training was demonstrated to be sufficient for enabling pediatric physicians to analyze subjective LV function and to measure dIVC, EF and CI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pediatric Intensive Care - Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University, Rua do Carreiro de Pedra 111 apto 152C, Jd, Caravelas, CEP 04728-020 São Paulo, Brazil. heloisaagaspar@uol.com.br.

ABSTRACT

Background: Focused echocardiographic examinations performed by intensivists and emergency room physicians can be a valuable tool for diagnosing and managing the hemodynamic status of critically ill children. The aim of this study was to evaluate the learning curve achieved using a theoretical and practical training program designed to enable pediatric intensivists and emergency physicians to conduct targeted echocardiograms.

Methods: Theoretical and practical training sessions were conducted with 16 pediatric intensivist/emergency room physicians. The program included qualitative analyses of the left ventricular (LV) and right ventricular (RV) functions, evaluation of pericardial effusion/cardiac tamponade and valvular regurgitation and measurements of the distensibility index of the inferior vena cava (dIVC), ejection fraction (EF) and cardiac index (CI). The practical training sessions were conducted in the intensive care unit; each student performed 24 echocardiograms. The students in training were evaluated in a practical manner, and the results were compared with the corresponding examinations performed by experienced echocardiographers. The evaluations occurred after 8, 16 and 24 practical examinations.

Results: The concordance rates between the students and echocardiographers in the subjective analysis of the LV function were 81.3% at the first evaluation, 96.9% at the second evaluation and 100% at the third evaluation (p < 0.001). For the dIVC, we observed a concordance of 46.7% at the first evaluation, 90.3% at the second evaluation and 87.5% at the third evaluation (p = 0.004). The means of the differences between the students' and echocardiographers' measurements of the EF and CI were 7% and 0.56 L/min/m2, respectively, after the third stage of training.

Conclusions: The proposed training was demonstrated to be sufficient for enabling pediatric physicians to analyze subjective LV function and to measure dIVC, EF and CI. This training course should facilitate the design of other echocardiography training courses that could be implemented in medical residency programs to improve these physicians' technical skills and the care of critically ill patients.

Show MeSH
Related in: MedlinePlus