Introduction: This narrative review focusing on critical care echocardiography (CCE) has been written by a group of experts in the field, with the aim of outlining the state of the art in CCE in the 10 years after its official recognition and definition. Results: In the last 10 years, CCE has become an essential branch of critical care ultrasonography and has gained general acceptance. Its use, both as a diagnostic tool and for hemodynamic monitoring, has increased markedly, influencing contemporary cardiorespiratory management. Recent studies suggest that the use of CCE may have a positive impact on outcomes. CCE may be used in critically ill patients in many different clinical situations, both in their early evaluation of in the emergency department and during intensive care unit (ICU) admission and stay. CCE has also proven its utility in perioperative settings, as well as in the management of mechanical circulatory support. CCE may be performed with very simple diagnostic objectives. This application, referred to as basic CCE, does not require a high level of training. Advanced CCE, on the other hand, uses ultrasonography for full evaluation of cardiac function and hemodynamics, and requires extensive training, with formal certification now available. Indeed, recent years have seen the creation of worldwide certification in advanced CCE. While transthoracic CCE remains the most commonly used method, the transesophageal route has gained importance, particularly for intubated and ventilated patients. Conclusion: CCE is now widely accepted by the critical care community as a valuable tool in the ICU and emergency department, and in perioperative settings.

Consensus was achieved to direct training curriculum, oversight, quality assurance and maintenance of competence for critical care ultrasound. In providing the first national guideline of its kind, these Canadian recommendations may also serve as a model of critical care ultrasound dissemination for other countries.

The use of point of care echocardiography by non-cardiologist in acute care settings such as the emergency department (ED) or the intensive care unit (ICU) is very common. Unlike diagnostic echocardiography, the scope of such point of care exams is often restricted to address the clinical questions raised by the patient’s differential diagnosis or chief complaint in order to inform immediate management decisions. In this article, an overview of the most common applications of this focused echocardiography in the ED and ICU is provided. This includes but is not limited to the evaluation of patients experiencing hypotension, cardiac arrest, cardiac trauma, chest pain and patients after cardiac surgery.

This large series of ECI shows an excellent long-term local control. It is a good alternative reconstruction method in selected patients. The overall survival is comparable to other published series.

BACKGROUND:Efficacy of simulators in teaching central venous catheterization (CVC) in an internal medicine residency program is unknown.OBJECTIVE:To determine whether or not learning CVC on simulators is associated with improvement in performance of CVC, knowledge about the procedure, and self‐reported confidence.METHODS:All consenting first‐year internal medicine residents who completed training in CVC on simulators were included. Participants were evaluated pre‐ and post‐training by video‐recorded CVC insertion and multiple‐choice knowledge assessments. Procedural technique was rated in a blinded fashion by two independent adjudicators. Knowledge retention and self‐reported confidence were reassessed at 18 months.MEASUREMENTS:Primary outcome of CVC performance was assessed based on global rating score (minimum 1, maximum 5). Secondary measures include checklist score (out of ten), knowledge score and self‐reported confidence (6‐point Likert scale ranging from “none” to “complete”).RESULTS:Median global rating scores in 30 participants increased from 3.5 (IQR = 3‐4) to 4.5 (IQR = 4‐4.5) (P < 0.001). Checklist score increased from 9 (IQR = 6‐9.5) to 9.5 (IQR = 9‐9.5) (P < 0.001). Knowledge score increased from 65.7 ± 11.9% to 81.2 ± 10.7% (P < 0.001). Confidence increased from 3 (“moderate”, IQR = 2‐3) to 4 (“good”, IQR=3‐4) (P < 0.001). Sixteen participants completed the retention tests. Improvement in knowledge score and confidence at 18 months was retained compared with baseline (P = 0.002 and P < 0.0001 respectively).CONCLUSIONS:Use of simulators in teaching CVC in an internal medicine residency program results in improved procedural performance, knowledge, and self‐reported confidence. Improvement in knowledge and confidence was retained at 18 months. Journal of Hospital Medicine 2009;4:410–416. © 2009 Society of Hospital Medicine.

BackgroundThe rapid adoption of point-of-care ultrasound (POCUS) has created a need to develop assessment tools to ensure that learners can competently use these technologies. In this study, the authors developed and tested a rating scale to assess the quality of point-of-care thoracic ultrasound studies performed by novices. In Phase 1, the Assessment of Competency in Thoracic Sonography (ACTS) scale was developed based on structured interviews with subject matter experts. The tool was then piloted on a small series of ultrasound studies in Phase 2. In Phase 3 the tool was applied to a sample of 150 POCUS studies performed by ten learners; performance was then assessed by two independent raters.ResultsEvidence for the content validity of the ACTS scale was provided by a consensus exercise wherein experts agreed on the general principles and specific items that make up the scale. The tool demonstrated reasonable inter-rater reliability despite minimal requirements for evaluator training and displayed evidence of good internal structure, with related scale items correlating well with each other. Analysis of the aggregate learning curves suggested a rapid early improvement in learner performance with slower improvement after approximately 25–30 studies.ConclusionsThe ACTS scale provides a straightforward means to assess learner performance. Our results support the conclusion that the tool is an effective means of making valid judgments regarding competency in point-of-care thoracic ultrasound, and that the majority of learner improvement occurs during their first 25–30 practice studies.

Given the general utility of lung ultrasound (LUS) for the evaluation of respiratory failure in acutely ill patients, it is logical to consider its specific advantages in COVID-19 related pulmonary disease. The authors, representing the extensive experience of the North American and European COVID-19 epicenters, present an ultrasound scanning protocol and report on the common associated ultrasound findings.

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