Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine,Intensive Care Medicine

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Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine
Intensive Care Medicine ( IF 38.9 ) Pub Date : 2021-10-05 , DOI: 10.1007/s00134-021-06486-z
Chiara Robba _{1,

2} , Adrian Wong ₃ , Daniele Poole ₄ , Ashraf Al Tayar ₅ , Robert T Arntfield ₆ , Michelle S Chew ₇ , Francesco Corradi _{8,

9} , Ghislaine Douflé ₁₀ , Alberto Goffi ₁₁ , Massimo Lamperti ₁₂ , Paul Mayo ₁₃ , Antonio Messina ₁₄ , Silvia Mongodi ₁₅ , Mangala Narasimhan ₁₆ , Corina Puppo ₁₇ , Aarti Sarwal ₁₈ , Michel Slama ₁₉ , Fabio S Taccone ₂₀ , Philippe Vignon ₂₁ , Antoine Vieillard-Baron _{22,

23} ,

Affiliation

Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genoa, Italy.
Italy and Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa, Italy.
Department of Critical Care, King's College Hospital, London, UK.
Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy.
Consultant Intensivist, Head of ICU/RT Department Security Forces Hospital , Dammam, Saudi Arabia.
Division of Critical Care Medicine, Western University, London, ON, Canada.
Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden.
Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
E.O. Ospedali Galliera, Genoa, Italy.
Interdepartmental Division of Critical Care Medicine, Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON, M5G 2N2, Canada.
Department of Medicine, Division of Critical Care Medicine, St. Michael's Hospital, Toronto, ON, Canada.
Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, USA.
Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.
Anaesthesia and Intensive Care, San Matteo Hospital, Pavia, Italy.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
Intensive Care Unit, Clinicas Hospital School of Medicine, University of the Republic, Montevideo, Uruguay.
Department of Neurology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
Medical Intensive Care Unit and INSERM U1088, Amiens University Hospital, Amiens, France.
Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Medical-Surgical Intensive Care Unit, Inserm CIC 1435, Limoges University Hospital, Limoges, France.
Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Billancourt, 92100, Boulogne, France.
INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.

Purpose

To provide consensus, and a list of experts’ recommendations regarding the basic skills for head-to-toe ultrasonography in the intensive care setting.

Methods

The Executive Committee of the European Society of Intensive Care (ESICM) commissioned the project and supervised the methodology and structure of the consensus. We selected an international panel of 19 expert clinicians–researchers in intensive care unit (ICU) with expertise in critical care ultrasonography (US), plus a non-voting methodologist. The panel was divided into five subgroups (brain, lung, heart, abdomen and vascular ultrasound) which identified the domains and generated a list of questions to be addressed by the panel. A Delphi process based on an iterative approach was used to obtain the final consensus statements. Statements were classified as a strong recommendation (84% of agreement), weak recommendation (74% of agreement), and no recommendation (less than 74%), in favor or against.

Results

This consensus produced a total of 74 statements (7 for brain, 20 for lung, 20 for heart, 20 for abdomen, 7 for vascular Ultrasound). We obtained strong agreement in favor for 49 statements (66.2%), 8 weak in favor (10.8%), 3 weak against (4.1%), and no consensus in 14 cases (19.9%). In most cases when consensus was not obtained, it was felt that the skills were considered as too advanced. A research agenda and discussion on training programs were implemented from the results of the consensus.

Conclusions

This consensus provides guidance for the basic use of critical care US and paves the way for the development of training and research projects.

中文翻译：

普通和神经重症监护病房人群的重症医师从头到脚的基本超声技能：欧洲重症监护医学会的共识和专家建议

目的

就重症监护环境中从头到脚超声检查的基本技能提供共识和专家建议列表。

方法

欧洲重症监护协会 (ESICM) 执行委员会委托该项目并监督共识的方法和结构。我们选择了一个由 19 名专家临床医生组成的国际小组——重症监护病房 (ICU) 的研究人员，他们在重症监护超声 (US) 方面具有专业知识，另外还有一名无投票权的方法学家。小组分为五个亚组（脑、肺、心脏、腹部和血管超声），确定了领域并生成了小组要解决的问题列表。基于迭代方法的 Delphi 过程用于获得最终的共识声明。声明分为强烈推荐（84% 的同意）、弱推荐（74% 的同意）和不推荐（低于 74%），赞成或反对。

结果

该共识产生了总共 74 条声明（脑部 7 条，肺部 20 条，心脏 20 条，腹部 20 条，血管超声 7 条）。我们对 49 个陈述（66.2%）获得了强烈同意，8 个不赞成（10.8%），3 个不同意（4.1%），14 个案例（19.9%）没有达成共识。在大多数情况下，在没有达成共识的情况下，人们认为这些技能被认为太先进了。根据共识的结果，实施了研究议程和培训计划讨论。