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Validation of a skills assessment scoring system for transesophageal echocardiographic monitoring of hemodynamics

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Abstract

Objective

Transesophageal echocardiography (TEE) is increasingly used in hemodynamic monitoring in the intensive care unit. This paper describes and validates a scoring system for assessing competence in TEE performed by intensivists for this indication.

Design

Prospective study over an 18-month period.

Settings

Two medical intensive care units.

Methods

The scoring system is used to assess four aspects of TEE: quality of the views (score out of 14); semiquantitative evaluation of respiratory variations in the superior vena cava, valve regurgitation, size of the right ventricle (score out of 10); accuracy of measurement of velocity-time integrals for pulmonary and aortic flow, peak velocity of the E and A waves of mitral flow, left ventricular fractional area change (score out of 8); summary and proposed treatment (score out of 8). The scoring system was validated by using it to assess intensivists after 1 month (M1), 3 months (M3) and 6 months (M6) of training. TEE was done on a mechanically ventilated, hypotensive patient and scored by comparing the intensivist's examination with that of the expert examiner. The intensivists were divided into two groups of theoretical expertise at the start of training.

Results

Nineteen intensivists were evaluated. The scores at M1 for level 0 (no experience in echocardiography) and level 1 (previous experience) were, respectively, 18.5 ± 4 and 24.7 ± 5. The scores at M1, M3, and M6 were, respectively, 20.4 ± 5, 30.4 ± 5 and 35.7 ± 3. At M6, the intensivists had performed TEE 29 ± 10 times.

Conclusion

The scoring system was discriminatory and sensitive to change, and could be used as a tool to assess an intensivist's mastery of TEE.

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Authors and Affiliations

  1. Medical Intensive Care Unit, University Hospital Ambroise Paré, 9 avenue Charles de Gaulle, 92104, Boulogne Cedex, France

    Cyril Charron, Vincent Caille, Guillaume Belliard, François Jardin & Antoine Vieillard-Baron

  2. Medical Intensive Care Unit, University Hospital of the Cavale Blanche, Brest, France

    Gwenaël Prat, Montaine Lefèvre & Jean-Michel Boles

  3. Department of Biostatistics, University Hospital Ambroise Paré, Assistance Publique Hôpitaux de Paris, 9 avenue Charles de Gaulle, 92104, Boulogne Cedex, France

    Philippe Aegerter

Authors
  1. Cyril Charron
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  2. Gwenaël Prat
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  3. Vincent Caille
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  4. Guillaume Belliard
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  5. Montaine Lefèvre
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  6. Philippe Aegerter
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  7. Jean-Michel Boles
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  8. François Jardin
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  9. Antoine Vieillard-Baron
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Corresponding author

Correspondence to Antoine Vieillard-Baron.

Additional information

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-007-0802-0.

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Charron, C., Prat, G., Caille, V. et al. Validation of a skills assessment scoring system for transesophageal echocardiographic monitoring of hemodynamics. Intensive Care Med 33, 1712–1718 (2007). https://doi.org/10.1007/s00134-007-0801-1

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  • DOI: https://doi.org/10.1007/s00134-007-0801-1

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