Learning curve for transesophageal echocardiography applied in mechanically ventilated patients in intensive care unit / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the learning curve of transesophageal echocardiography (TEE) applied in mechanically ventilated patients in intensive care unit (ICU).Methods A prospective observation study was conducted. A total of 60 consecutive patients necessary for mechanical ventilation and TEE examination admitted to the Department of Surgical ICU of the First Affiliated Hospital of Sun Yat-Sen University from December 2016 to June 2017 were enrolled. The TEE examination was performed by the same ICU physician who was skilled in transthoracic echocardiography (TTE). The TEE probe intubation (trial numbers of TEE intubation, the duration for a successful intubation at the first attempt, the total time for successful intubation), TEE examination (the scores of TEE examination, the duration of TEE examination), and the complication during examination were observed, with learning curve established. According to the date of examination, a statistical analysis was carried out for each group of 12 cases. Through the learning curve, that TEE examinations in how many cases should be performed by the ICU physician to master the skill was observed.Results With the increase of TEE examinations performed by the physician, the duration for a successful intubation at the first attempt and the total time for successful intubation were gradually reduced; the scores of TEE examination were gradually increased, and the duration of TEE examination gradually reduced. ① TEE intubation there was no statistical significant difference among the 60 patients in the number of intubation attempts (F = 0.258,P = 0.904). After the SICU doctor completed TEE intubations in 12 cases, the duration for a successful intubation at the first attempt was significantly reduced (seconds 22.24±18.37 vs. 34.88±1.65,P < 0.05) and then tended to stabilize in the 16 - 23 seconds. The learning curve indicated that the physician could basically master the intubation skills after performing TEE intubations in 24 cases. ② TEE examination after the physician completed TEE intubations in 24 cases, the TEE examination scores were increased significantly (40.08±7.27 vs. 23.67±9.70,P < 0.05), and then tended to stabilize in the 40 - 47 scores; after TEE intubations were performed in 24 cases, the examination duration was significantly shortened (minutes 39.97±6.67 vs. 58.22±14.19,P < 0.05), and after 36 cases were completed, the duration could be further shortened (minutes31.04±7.84 vs. 39.97±6.67,P < 0.05). The learning curve indicated that the ICU physician could basically master the examination skills when TEE examinations were completed in 36 cases. In addition, no serious complications occurred during the TEE examination.Conclusions A SICU physician with skilled TTE experience can basically master the TEE technology through 36 times of examinations, and reach full mastery after 48 times, the duration for a successful intubation at the first attempt could be stabilized at 20 seconds, and the examination duration could be stabilized at 30 minutes.