Uso da ecocardiografia à beira do leito no cuidado do paciente grave - Parte 1
um documento conjunto de consenso da Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência e Sociedade Brasileira de Medicina Hospitalar.
DOI:
https://doi.org/10.54143/jbmede.v3i1.119Palavras-chave:
Ultrassonografia, Cuidados críticos, Sistemas automatizados de assistência junto ao leito, ConsensoResumo
O emprego da ecocardiografia por médicos não ecocardiografistas tem se tornado comum em todo o mundo nos mais diversos ambientes em que se dá o cuidado do paciente agudamente doente. A avaliação ecocardiográfica realizada de forma point-of-care pode fornecer informações pertinentes em relação ao mecanismo das causas de choque, por exemplo, incrementando as taxas de diagnóstico correto e possibilitando a tomada de decisão fundamentada de forma mais rápida do que por meio dos métodos tradicionais de avaliação. Considerando que o diagnóstico preciso de situações ameaçadoras à vida é indispensável a profissionais atuando junto a pacientes agudamente enfermos, diversas entidades associativas internacionais recomendam que médicos responsáveis por pacientes gravemente doentes devam adquirir e desenvolver a habilidade para realizar exames ultrassonográficos à beira do leito, inclusive ecocardiográficos. Entretanto, não há consenso na literatura acerca de quais aplicações específicas devam compor o rol de habilidades do médico não ecocardiografista. Levando-se em consideração a multiplicidade de aplicações da ecocardiografia em diversos cenários relativos ao paciente agudamente enfermo; as diferenças nos protocolos publicados, tanto no que diz respeito à metodologia de ensino como de verificação de competências, bem como a heterogeneidade da formação entre as mais diversas especialidades responsáveis pelo seu cuidado em diferentes níveis, este documento de consenso teve o objetivo de refletir o posicionamento de representantes de sociedades médicas brasileiras afins acerca do tema, podendo, assim, servir de ponto de partida para a uniformização entre diferentes especialidades, bem como para a transmissão de conhecimento e a verificação das competências correspondentes.
Referências
Vieillard-Baron A, Millington SJ, Sanfilippo F, Chew M, Diaz-Gomez J, McLean A, et al. A decade of progress in critical care echocardiography: a narrative review. Intensive care Med. 2019;45(6):770-88.
Jones AE, Tayal VS, Sullivan DM, Kline JA. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med. 2004;32(8):1703-8.
Hall MK, Taylor RA, Luty S, Allen IE, Moore CL. Impact of point-of-care ultrasonography on ED time to disposition for patients with nontraumatic shock. Am J Emerg Med. 2016;34(6):1022-30.
Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, et al. American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest. 2009;135(4):1050-60.
Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26(6):567-81.
Expert Round Table on Echocardiography in ICU. International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med. 2014;40(5):654-66.
Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II: Cardiac Ultrasonography. Crit Care Med. 2016;44(6):1206-27.
Pellegrini JA, Cordioli RL, Grumann AC, Ziegelmann PK, Taniguchi LU. Point-of-care ultrasonography in Brazilian intensive care units: a national survey. Ann Intensive Care. 2018;8(1):50.
Mayo P, Arntfield R, Balik M, Kory P, Mathis G, Schmidt G, et al. The ICM research agenda on critical care ultrasonography. Intensive Care Med. 2017;43(9):1257-69.
McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm. 2016;38(3):655-62.
Douglas PS, Khandheria B, Stainback RF, Weissman NJ, Brindis RG, Patel MR, Khandheria B, Alpert JS, Fitzgerald D, Heidenreich P, Martin ET, Messer JV, Miller AB, Picard MH, Raggi P, Reed KD, Rumsfeld JS , Steimle AE, Tonkovic R, Vijayaraghavan K, Weissman NJ, Yeon SB, Brindis RG, Douglas PS, Hendel RC, Patel MR, Peterson E, Wolk MJ, Allen JM; American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group; American Society of Echocardiography; American College of Emergency Physicians; American Society of Nuclear Cardiology; Society for Cardiovascular Angiography and Interventions; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American College of Chest Physicians; Society of Critical Care Medicine. ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 Appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians , American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. J Am Coll Cardiol. 2007;50(2):187-204.
Johri AM, Durbin J, Newbigging J, Tanzola R, Chow R, De S, et al. Cardiac Point-of-Care Ultrasound: State-of-the-Art in Medical School Education. J Am Soc Echocardiogr. 2018;31(7):749-60.
Becker TK, Tafoya CA, Osei-Ampofo M, Tafoya MJ, Kessler RA, Theyyunni N, et al. Cardiopulmonary ultrasound for critically ill adults improves diagnostic accuracy in a resource-limited setting: the AFRICA trial. Trop Med Int Health. 2017;22(12):1599-608.
Shokoohi H, Boniface KS, Pourmand A, Liu YT, Davison DL, Hawkins KD, et al. Bedside ultrasound reduces diagnostic uncertainty and guides resuscitation in patients with undifferentiated hypotension. Crit Care Med. 2015;43(12):2562-9.
Zieleskiewicz L, Lopez A, Hraiech S, Baumstarck K, Pastene B, Di Bisceglie M, et al. Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: an observational, prospective, controlled study. Crit Care. 2021;25(1):34.
Volpicelli G, Lamorte A, Tullio M, Cardinale L, Giraudo M, Stefanone V, et al. Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med. 2013;39(7):1290-8.
Blans MJ, Bousie E, van der Hoeven JG, Bosch FH. A point-of-care thoracic ultrasound protocol for hospital medical emergency teams (METUS) improves diagnostic accuracy. Ultrasound J. 2021;13(1):29.
Expert Round Table on Ultrasound in ICU. International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011;37(7):1077-83.
Neskovic AN, Skinner H, Price S, Via G, De Hert S, Stankovic I, Galderisi M, Donal E, Muraru D, Sloth E, Gargani L, Cardim N, Stefanidis A, Cameli M, Habib G, Cosyns B, Lancellotti P, Edvardsen T, Popescu BA; Reviewers: This document was reviewed by members of the 2016–2018 EACVI Scientific Documents Committee. Focus cardiac ultrasound core curriculum and core syllabus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2018;19(5):475-81.
McLean AS. International recommendations on competency in critical care ultrasound: pertinence to Australia and New Zealand. Crit Care Resusc. 2011;13(1):56-8.
Arntfield R, Millington S, Ainsworth C, Arora R, Boyd J, Finlayson G, et al. Canadian recommendations for critical care ultrasound training and competency. Can Respir J. 2014;21(6):341-5.
Via G, Hussain A, Wells M, Reardon R, ElBarbary M, Noble VE, Tsung JW, Neskovic AN, Price S, Oren-Grinberg A, Liteplo A, Cordioli R, Naqvi N, Rola P, Poelaert J, Guliĉ TG, Sloth E, Labovitz A, Kimura B, Breitkreutz R, Masani N, Bowra J, Talmor D, Guarracino F, Goudie A, Xiaoting W, Chawla R, Galderisi M, Blaivas M, Petrovic T, Storti E, Neri L, Melniker L; International Liaison Committee on Focused Cardiac UltraSound (ILC-FoCUS); International Conference on Focused Cardiac UltraSound (IC-FoCUS). International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr. 2014;27(7):683.e1-e33.
Price S, Via G, Sloth E, Guarracino F, Breitkreutz R, Catena E, Talmor D; World Interactive Network Focused on Critical UltraSound ECHO-ICU Group. Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS). Cardiovasc Ultrasound. 2008;6:49.
Ayuela Azcarate JM, Clau-Terré F, Vicho Pereira R, Guerrero de Mier M, Carrillo López A, Ochagavia A, López Pérez JM, Trenado Alvarez J, Pérez L, Llompart-Pou JA, González de Molina FJ, Fojón S, Rodríguez Salgado A, Martínez Díaz MC, Royo Villa C, Romero Bermejo FJ, Ruíz Bailén M, Arroyo Díez M, Argueso García M, Fernández Fernández JL; Grupo de Trabajo de Cuidados Intensivos Cardiológicos y RCP de la SEMICYUC. [Consensus document on ultrasound training in Intensive Care Medicine. Care process, use of the technique and acquisition of professional skills]. Med Intensiva. 2014;38(1):33-40. Spanish.
Millington SJ, Goffi A, Arntfield RT. Critical care echocardiography: a certification pathway for advanced users. Can J Anaesth. 2018;65(4):345-9.
Melamed R, Sprenkle MD, Ulstad VK, Herzog CA, Leatherman JW. Assessment of left ventricular function by intensivists using hand-held echocardiography. Chest. 2009;135(6):1416-20.
Vignon P, Mücke F, Bellec F, Marin B, Croce J, Brouqui T, et al. Basic critical care echocardiography: validation of a curriculum dedicated to noncardiologist residents. Crit Care Med. 2011;39(4):636-42.
Beraud AS, Rizk NW, Pearl RG, Liang DH, Patterson AJ. Focused transthoracic echocardiography during critical care medicine training: curriculum implementation and evaluation of proficiency. Crit Care Med. 2013;41(8):e179-81.
Kanji HD, McCallum JL, Bhagirath KM, Neitzel AS. Curriculum development and evaluation of a hemodynamic critical care ultrasound: a systematic review of the literature. Crit Care Med. 2016;44(8):e742-50.
Monnet X, Shi R, Teboul JL. Prediction of fluid responsiveness. What's new? Ann Intensive Care. 2022;12(1):46.
Kattan E, Castro R, Miralles-Aguiar F, Hernández G, Rola P. The emerging concept of fluid tolerance: a position paper. J Crit Care. 2022;71:154070.
Kobal SL, Trento L, Baharami S, Tolstrup K, Naqvi TZ, Cercek B, et al. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Am J Cardiol. 2005;96(7):1002-6.
Hammadah M, Ponce C, Sorajja P, Cavalcante JL, Garcia S, Gössl M. Point-of-care ultrasound: closing guideline gaps in screening for valvular heart disease. Clin Cardiol. 2020;43(12):1368-75.
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