• Charlotte Arbelot, Felippe Leopoldo Dexheimer Neto, Yuzhi Gao, Hélène Brisson, Wang Chunyao, Jie Lv, Carmen Silvia Valente Barbas, Sébastien Perbet, Fabiola Prior Caltabellotta, Frédérick Gay, Romain Deransy, Emidio J S Lima, Andres Cebey, Antoine Monsel, Julio Neves, Mao Zhang, Du Bin, Youzhong An, Luis Malbouisson, Jorge Salluh, Jean-Michel Constantin, Jean-Jacques Rouby, and APECHO Study Group.
• From the Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine (C.A., H.B., R.D., A.M., J.-M.C., J.-J.R.) the Department of Parasitology-Mycology (F.G.), La Pitié-Salpêtrière Hospital, Public Assistance of Paris Hospitals (AP HP), Sorbonne University of Paris, Paris, France Intensive Care Unit, Federal University of Rio Grande do Sul, Ernesto Dornelles Hospital, Moinhos de Vento Hospital, Postgraduate Program for Pulmonology Science, Porto Alegre, Brazil (F.L.D.N.) the Department of Emergency Medicine, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Institute of Emergency Medicine, Hangzhou, China (Y.G., M.Z.) the Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China (W.C., D.B.) the Department of Critical Care Medicine, Peking University People's Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (J.L., Y.A.) the Multidisciplinary Intensive Care Unit, Hospital Albert Einstein, São Paulo, Brazil (C.S.V.B.) the Department of Perioperative Medicine, Centre Hospitalo-Universitaire Clermont-Ferrand, University Clermont Auvergne, National Institute for Health and Medical Research (INSERM), National Center for Scientific Research (CNRS), Clermont-Ferrand, France (S.P.) University of São Paulo, Surgical and Trauma Intensive Care Unit, Hospital Das Clinicas, São Paulo, Brazil (F.P.C., L.M.) the Multidisciplinary Intensive Care Unit, Hospital da Bahia, Salvador and Santa Helena Hospital, Salvador, Brazil (E.J.S.L., J.N.) La Republica University, Intensive Care Unit, Hospital de Clínicas Dr. Manuel Qintela, University School of Medicine, Montevideo, Uruguay (A.C.) the Multidisciplinary Intensive Care Unit, Hospital Copa D'Or, Rio de Janeiro, Brazil (J.S.).
• Anesthesiology. 2020 Apr 1; 132 (4): 899-907.

BackgroundLung ultrasound is increasingly used in critically ill patients as an alternative to bedside chest radiography, but the best training method remains uncertain. This study describes a training curriculum allowing trainees to acquire basic competence.MethodsThis multicenter, prospective, and educational study was conducted in 10 Intensive Care Units in Brazil, China, France and Uruguay. One hundred residents, respiratory therapists, and critical care physicians without expertise in transthoracic ultrasound (trainees) were trained by 18 experts. The main study objective was to determine the number of supervised exams required to get the basic competence, defined as the trainees' ability to adequately classify lung regions with normal aeration, interstitial-alveolar syndrome, and lung consolidation. An initial 2-h video lecture provided the rationale for image formation and described the ultrasound patterns commonly observed in critically ill and emergency patients. Each trainee performed 25 bedside ultrasound examinations supervised by an expert. The progression in competence was assessed every five supervised examinations. In a new patient, 12 pulmonary regions were independently classified by the trainee and the expert.ResultsProgression in competence was derived from the analysis of 7,330 lung regions in 2,562 critically ill and emergency patients. After 25 supervised examinations, 80% of lung regions were adequately classified by trainees. The ultrasound examination mean duration was 8 to 10 min in experts and decreased from 19 to 12 min in trainees (after 5 vs. 25 supervised examinations). The median training duration was 52 (42, 82) days.ConclusionsA training curriculum including 25 transthoracic ultrasound examinations supervised by an expert provides the basic skills for diagnosing normal lung aeration, interstitial-alveolar syndrome, and consolidation in emergency and critically ill patients.

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