Results of short-term training of naïve physicians in focused general ultrasonography in an intensive-care unit.

Abstract

To evaluate limited training of ICU physicians without knowledge of ultrasound in performing basic general ultrasonography. A prospective, observational, study conducted in a 14-bed MICU. Seventy-seven critically ill patients (38 females) aged 64 +/- 16 years, with a SAPS II score of 47 +/- 21, 49 of whom (64%) were receiving mechanical ventilation. After 8.5 h of training comprising a 2.5 h didactic course that included essential views of normal and pathologic conditions and three hands-on sessions of 2 h each, one of eight ICU residents and the radiologist on duty performed the same examination in a blind manner. The questions addressed concerned the presence of pleural effusion, intra-abdominal effusion, acute cholecystitis, intrahepatic biliary duct dilation, obstructive uropathy, chronic renal disease, and deep venous thrombosis. The answers to 129 questions were analyzed. The possible presence of pleural effusion, and arguments for the presence of urinary tract obstruction and chronic renal insufficiency, were the questions most frequently addressed. Residents answered 84.4% of the questions correctly [Kappa: 0.66, CI 95% (0.32-1.12)]. Most of the discrepancies concerned small non-drainable pleural or abdominal effusions. For questions with a potential therapeutic impact, residents answered 95% of the questions correctly [Kappa 0.86, CI 95% (0.75-1.04)]. Residents completed the examination in 37 +/- 39 min compared with 296 +/- 487 min for the radiologists (P = 0.004). These results suggest that after brief focused training, intensive-care unit physicians without previous knowledge of ultrasonography can competently perform basic general ultrasonic examinations.