The following is a summary of “Therapeutic impact of basic critical care echocardiography performed by residents after limited training,” published in the July 2024 issue of Critical Care by Goudelin et al.

Researchers conducted a retrospective study evaluating the agreement in therapeutic recommendations between novice and expert operators using essential critical care echocardiography and assessing concordance in clinical responses and two-dimensional measurements.

They involved adult patients experiencing acute circulatory or respiratory failure in a medical-surgical ICU who required transthoracic echocardiography (TTE). Each patient underwent TTE independently by a novice resident in ultrasonography, following brief training, and an expert within the same hour and in random order. Both operators answered standardized clinical questions and provided therapeutic strategies based on a predefined algorithm.

The result showed an average of 33 TTE studies across 244 patients, 156 men with a median age of 63 years (52–74), in which SAPS2 scores were 45 [34–59], 182 patients, or 75%, were MV. The agreement between therapeutic recommendations made by residents and experienced operators ranged from good to excellent. Concordance was notably high for recommendations regarding fluid loading, inotrope, or vasopressor support, with Kappa values exceeding 0.80. An inter-observer agreement was only moderate for recommending a negative fluid balance (Kappa: 0.65; 95% CI 0.50–0.80), as residents suggested diuretics for 23 patients (9.5%) while experts made the same recommendation for 35 patients (14.4%). Overall, responses to simple clinical questions demonstrated good-to-excellent agreement. The intraclass correlation coefficient for measuring ventricular and inferior vena cava sizes surpassed 0.75.

Investigators concluded that a basic training program in critical care echocardiography allowed residents of the ICU to propose therapeutic interventions with a good-to-excellent agreement with experienced operators.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01354-7