Abstract
Purpose of Review
Training and education that culminate in the mastery of Critical Care Ultrasound (CCU) requires a complex systems based approach. We explore an update of the building blocks and barriers to CCU programs.
Recent Findings
Critical Care Ultrasound training and education is competency based in order to assure it meets a high standard. Despite multiple CCU guidelines, implementation of a robust CCU training and education system continues to be challenging. Elements that are essential and are currently considered barriers for the implementation of effective CCU programs include a thorough evidenced based training methodology across all CCU applications and the availability of expertly trained mentors.
Summary
The most recent CHEST guidelines offer an evidence-based step by step process across a competency based framework of one component of CCU. Other applications of CCU have not been addressed in this regard. We propose a framework for CCU programs with solutions to the major barriers faced by programs wanting to implement a CCU educational system.
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Data Availability
No datasets were generated or analyzed during the current study.
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Via G, Hussain A, Wells M, et al. International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr. 2014;27:683.e1–683.e33.
• Kirkpatrick JN, Grimm R, Johri AM, et al. Recommendations for echocardiography laboratories participating in cardiac point of care cardiac ultrasound (POCUS) and critical care echocardiography training: report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2020;33:409–422.e4. These new guidelines proposed by the American Society of Echocardiography offer a streamlined approach to training in cardiac ultrasound by using the CCU local resources.
Levitov A, Frankel HL, Blaivas M, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part II: cardiac ultrasonography. Crit Care Med. 2016;44:1206–27.
Mayo PH, Beaulieu Y, Doelken P, et al. American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. Chest. 2009;135:1050–60.
Pustavoitau A, Blaivas M, Brown S, et al. Recommendations for achieving and maintaining competency and credentialing in critical care ultrasound with focused cardiac ultrasound. Ultrasound Certification Task Force: Official Statement of The Society of Critical Care Medicine; 2016.
Beaulieu Y. Specific skill set and goals of focused echocardiography for critical care clinicians. Crit Care Med. 2007;35:S144–9.
Neskovic AN, Skinner H, Price S, et al. Focus cardiac ultrasound core curriculum and core syllabus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2018;19:475–81.
Frankel HL, Kirkpatrick AW, Elbarbary M, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part I: general ultrasonography. Crit Care Med. 2015;43(11):2479–502.
•• Rajamani A, Galarza L, Sanfilippo F, et al. Criteria, processes, and determination of competence in basic critical care echocardiography training: a delphi process consensus statement by the learning ultrasound in critical care (LUCC) initiative. Chest. 2022;161:492–503. These new guidelines offer an evidence based systematic approach to the learning experience of Basic CCE.
Fagley RE, Haney MF, Beraud A-S, Comfere T, Kohl BA, Merkel MJ, Pustavoitau A, von Homeyer P, Wagner CE, Wall MH. Critical care basic ultrasound learning goals for american anesthesiology critical care trainees: recommendations from an expert group. Anesth Analg. 2015;120:1041–53.
Price S, Via G, Sloth E, Guarracino F, Breitkreutz R, Catena E, Talmor D, World Interactive Network Focused On Critical UltraSound ECHO-ICU Group. Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS). Cardiovasc Ultrasound. 2008;6:49.
Wong A, Galarza L, Forni L, et al. Recommendations for core critical care ultrasound competencies as a part of specialist training in multidisciplinary intensive care: a framework proposed by the European Society of Intensive Care Medicine (ESICM). Crit Care. 2020;24:393.
Expert Round Table on Ultrasound in ICU. International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011;37:1077–83.
Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014;113:12–22.
American College of Emergency Physicians. American College of Emergency Physicians. ACEP emergency ultrasound guidelines-2001. Ann Emerg Med. 2001;38:470–81.
Fletcher SN, Grounds RM. Critical care echocardiography: cleared for take up. Br J Anaesth. 2012;109:490–2.
Neri L, Storti E, Lichtenstein D. Toward an ultrasound curriculum for critical care medicine. Crit Care Med. 2007;35:S290–304.
Bodenham AR. Editorial II: ultrasound imaging by anaesthetists: training and accreditation issues. Br J Anaesth. 2006;96:414–7.
Huang SJ, McLean AS. Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective. Crit Care. 2010;14:313.
•• Rajamani A, Shetty K, Parmar J, Huang S, Ng J, Gunawan S, Gunawan G, SPARTAN Collaborative (Small Projects, Audits and Research Projects – Australia/New Zealand). Longitudinal competence programs for basic point-of-care ultrasound in critical care: a systematic review. Chest. 2020;158:1079–89. This systematic review exposes the longitudinal competence programs on CCUs.
• Rajamani A, Knudsen S, Bich Ha Huynh K, et al. Basic echocardiography competence program in intensive care units: a multinational survey of intensive care units accredited by the College of Intensive Care Medicine. Anaesth Intensive Care. 2020;48:150–4. This survey evaluates the current barriers to Basic CCE.
Mosier JM, Malo J, Stolz LA, Bloom JW, Reyes NA, Snyder LS, Adhikari S. Critical care ultrasound training: a survey of US fellowship directors. J Crit Care. 2014;29:645–9.
Yorkgitis BY, Bryant EA, Brat GA, et al. Ultrasound training and utilization in surgical critical care fellowships: a program director’s survey. J Surg Res. 2017;218:292–7.
• Slemko JM, Daniels VJ, Bagshaw SM, Ma IWY, Brindley PG, Buchanan BM. Critical care ultrasound training: a survey exploring the “education gap” between potential and reality in Canada. Ultrasound J. 2021;13:48. This survey evaluates the current barriers to Basic CCE.
• Rajamani A, Smith L, Gunawan S, Gunawan G, Parmar J, Arvind H, Huang S, SPARTAN Collaborative (Small Projects, Audits and Research Projects-Australia/New Zealand). Methodologic quality of guidelines for training or competence processes for basic point-of-care echocardiography in critical care: a systematic review of the literature. Chest. 2021;160:616–23. This systematic review evaluates methodology of the literature on CCU.
Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, Porter TR, Spencer KT, Tayal VS, Wei K. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010;23:1225–30.
Pustavoitau A, Miller D, Jung Y-H, Sahu K, Giammarino A, Fitz N, Gottschalk A, Hoenig B, Bughrara N. Barriers to focused cardiac ultrasound training: a survey of anesthesiology program directors. J Clin Anesth. 2023;85:111013.
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K.R. and E.R. wrote the main manuscript text. All authors reviewed the manuscript.
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Author A declares the following relationships not covered in disclosure form: He is the creator of showmethepocus.com which is an open source POCUS website for Anesthesiology. He does not receive grants or funds from the website. Author B declares he has no conflicts of interest. Perceived conflict of interest: Dr Rocuts is the creator of showmethepocus.com which is a Anesthesia related POCUS website that is open source and free to use. No funding from this website was used in the making of this manuscript.
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Rocuts, K.A., Riveros-Perez, E. Training and Education in Point of Care Ultrasound in Critical Care: An Update. Curr Pulmonol Rep (2024). https://doi.org/10.1007/s13665-024-00343-2
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DOI: https://doi.org/10.1007/s13665-024-00343-2