Critical care ultrasound training: a survey exploring the “education gap” between potential and reality in Canada

Background Critical care ultrasound (CCUS) is now a core competency for Canadian critical care medicine (CCM) physicians, but little is known about what education is delivered, how competence is assessed, and what challenges exist. We evaluated the Canadian CCUS education landscape and compared it against published recommendations. Methods A 23-item survey was developed and incorporated a literature review, national recommendations, and expert input. It was sent in the spring of 2019 to all 13 Canadian Adult CCM training programs via their respective program directors. Three months were allowed for data collection and descriptive statistics were compiled. Results Eleven of 13 (85%) programs responded, of which only 7/11 (64%) followed national recommendations. Curricula differed, as did how education was delivered: 8/11 (72%) used hands-on training; 7/11 (64%) used educational rounds; 5/11 (45%) used image interpretation sessions, and 5/11 (45%) used scan-based feedback. All 11 employed academic half-days, but only 7/11 (64%) used experience gained during clinical service. Only 2/11 (18%) delivered multiday courses, and 2/11 (18%) had mandatory ultrasound rotations. Most programs had only 1 or 2 local CCUS expert-champions, and only 4/11 (36%) assessed learner competency. Common barriers included educators receiving insufficient time and/or support. Conclusions Our national survey is the first in Canada to explore CCUS education in critical care. It suggests that while CCUS education is rapidly developing, gaps persist. These include variation in curriculum and delivery, insufficient access to experts, and support for educators.

Critical Care Ultrasound Oriented Shock Treatment in Intensive Care Unit: A Randomized Controlled Trial

Objective: To determine whether our established Pathophysiology and etiology treatment for shock based on critical ultrasonography (PESCUS) workflow is superior to standard care in the setting of Intensive Care Unit (ICU). Materials and Methods: This is a prospective randomized controlled study. Critically ill adult shock patients were assigned to critical care ultrasound oriented treatment (CUOT) group who received treatment designed for different phases of shock guided by PESCUS workflow or standard care (SC) group who received standard care without treatment guided by PESCUS workflow.Results: Of the 147 enrolled patients, 77 were assigned to the CUOT group and 70 to the SC group. There were no significant difference between the two groups at baseline. The ICU mortality in CUOT group was significantly lower (29.9% vs. 45.7%, P=0.047). The CUOT group received significantly less fluid than SC group in the stabilization and de-escalation phases. The median duration of stabilization and de-escalation phase of shock in CUOT group was 35.0 [IQR 19.3-59.8] hours compared with 60.0[IQR 24.0-78.0] hours in SC group, p=0.024). Conclusions: Our study suggests utilization of PESCUS workflow can potentially improve ICU outcome in shock patient and avoid unnecessary fluid overload during shock recovery phase. Trial registration: Critical Care Ultrasound Oriented Shock Treatment in ICU, (28/03/2017) NCT03093987，Registered, Retrospectively registered .

Lung Ultrasound and Sonographic Subpleural Consolidation in COVID-19 Pneumonia Correlate with Disease Severity

Introduction. One of the ultrasonic features of COVID-19 pneumonia is the presence of subpleural consolidation (SPC), and the number of SPCs varies among patients with COVID-19 pneumonia. Aim. To examine the relationship between disease severity and the number of SPCs on admission. Methodology. This observational, prospective, single‐center study included patients with suspected COVID-19 infection who had been transferred to the ICU. A specialized intensivist in critical care ultrasound performed lung ultrasound (LUS) and echocardiography within 12 hours of a patient’s admission to the ICU. The aeration score was calculated, and the total number of SPCs was quantified in 12 zones of the LUS. Results. Of 109 patients with suspected COVID-19 pneumonia, 77 (71%) were confirmed. The median patient age was 53 (82–36) years, and 81 of the patients (73.7%) were men. The aeration score and the counts of subpleural consolidation in each zone were significantly higher in patients with COVID-19 pneumonia ( P = 0.018 and P < 0.0001 , respectively). There was an inverse relationship between PO2/FiO2, the aeration score, and the number of subpleural consolidations. The higher the number of SPCs, the worse the PO2/FiO2 will be. Conclusions. Sonographic SPC counts correlate well with the severity of COVID-19 pneumonia and PO2/FiO2. The number of SPCs should be considered when using LUS to assess disease severity.

Surgical Intensivist-Led Training in Critical Care Ultrasound Improves Performance

Background Critical care ultrasound (CCUS) is essential in modern practice, with CCUS including cardiac and noncardiac ultrasound. The most effective CCUS training is unknown, with a diverse skill set and knowledge needed for competence. The objective of this project was to evaluate the effect of a surgical intensivist-led training program on CCUS competence in critical care fellows. Methods This was a single institution retrospective review from 2016 to 2018 at the R Adams Cowley Shock Trauma Center. Our yearlong surgical intensivist (SI)-led CCUS training program for critical care fellows includes a daylong CCUS training class, CCUS lectures, a CCUS rotation, and bedside CCUS instruction during rotations. Fellows take a knowledge test and skills test before (pretest) and after (posttest) this program. Critical care ultrasound skill was graded on a scale from 1-5, with 4 (minimal help) or 5 (no help) considered competent. Emergency medicine, surgery, and medicine-trained critical care fellows were included. Results Forty-two critical care fellows were included. Mean posttest scores increased significantly for 21/22 (96%) of skills tested and for 14/30 (47%) of knowledge questions compared to pretest scores. The mean composite skill score increased from 3.25 to 4.82 from pretest to posttest ( P < .001). The mean composite knowledge score increased from 60% to 80% from pretest to posttest ( P < .001). Conclusion SI-led training improves CCUS competence and knowledge despite the breadth of CCUS.

Abstract 13704: Simulation-based Uptraining Improves Provider Comfort in the Management of Critically Ill Patients With Covid-19

Introduction: The COVID-19 surge at our institution required deployment of large numbers of non-intensive care unit (ICU) physicians and advanced practice providers to assist in the management of the critically ill. A 3-hour “uptraining” simulation session was offered to these providers that focused on various aspects of ICU care. Hypothesis: We hypothesized that following a 3-hour simulation session, providers would feel more comfortable in managing critically-ill patients with COVID-19. Methods: One hundred and seventy-five providers underwent a 3-hour simulation-based session focused on management of shock, acute respiratory distress syndrome, and critical care ultrasound. All participants were sent surveys to assess their comfort with various aspects of ICU care following return to their usual work environments. Results: One hundred and eight providers of 175 (62%) completed the surveys. Cardiology fellows and faculty accounted for 36% of the responders, acute care nurse practitioners (NPs) accounted for 16%, while other NPs, residents, and fellows accounted for the remainder. Prior to simulation training, 31% regularly managed patients in the ICU and 28% occasionally managed ICU patients. Following training, 71% of participants were deployed to a COVID-19 ICU as part of their workflow. Overall, 104/108 responders (96%) felt training either significantly or somewhat improved their knowledge in the management of ICU patients. Ninety-four participants (91%) felt training impacted their care of critically ill patients with COVID-19. Table 1 is a display of specific ICU skillsets taught in the session and if the participants felt better equipped to utilize what was covered post deployment. Conclusions: Simulation-based training improved provider comfort in the management of critically ill patients with COVID-19. Table 1: Participants response to “if they felt better equipped to utilize ICU skills following simulation training”