RESUMO
BACKGROUND: Excessive extravascular lung water (EVLW) is associated with increased morbidity and mortality. We compared three lung-ultrasound (L-US) techniques against the reference-standard transpulmonary thermodilution (TPTD) technique to access EVLW. MATERIALS AND METHODS: This was a prospective, single-blind, cross-sectional study. Forty-four septic patients were enrolled. EVLW index was measured by the TPTD method, and an index of ≥10 mL/kg was considered diagnostic of pulmonary edema. EVLW index was then compared to three established bedside L-US protocols that evaluate sonographic B-lines: (1) a 28-zone protocol (total B-line score [TBS]) (2) a scanning 8-region examination, and (3) a 4-point examination. RESULTS: Eighty-nine comparisons were obtained. A statistically significant positive correlation was found between L-US TBS and an EVLW index ≥10 mL/kg (r = 0.668,P < 0.001). The 28-zone protocol score ≥39 has a sensitivity of 81.6% and a specificity of 76.5% to define EVLW index ≥10 mL/kg. In contrast, the positive 4-point examination and scanning 8-regions showed low sensitivity (23.7% and 50.0%, respectively) but high specificity (96.1% and 88.2%, respectively). Ten patients with a total of 21 comparisons met criteria for acute respiratory distress syndrome (ARDS). In this subgroup, only the TBS had statistically significant positive correlation to EVLW (r = 0.488,P = 0.025). CONCLUSION: L-US is feasible in patients with severe sepsis. In addition, L-US 28-zone protocol demonstrated high specificity and better sensitivity than abbreviated 4- and 8-zone protocols. In ARDS, the L-US 28-zone protocol was more accurate than the 4- and 8-zone protocols in predicting EVLW. Consideration of limitations of the latter protocols may prevent clinicians from reaching premature conclusions regarding the prediction of EVLW. TRIAL REGISTRATION: ISRCTN11419081. Registered 4 February 2015 retrospectively.
RESUMO
BACKGROUND: Most medical errors are nontechnical and include failures in team communication, situational awareness, resource use, and leadership. Other high-risk industries have adopted team-based crisis resource management (CRM) training strategies to address "nontechnical" skills and to improve human error and safety. Here, we describe the development and evaluation of a national multidisciplinary trauma CRM curriculum. METHODS: A needs analysis survey was distributed to general surgery program directors across Canada. With the use of this feedback, a course called STARTT [Standardized Trauma and Resuscitation Team Training] was developed and held in conjunction with the Canadian Surgery Forum. Participants completed a precourse and postcourse evaluation exploring changes in attitudes toward simulation and CRM principles using previously validated instruments. RESULTS: Twenty surgical residents, 6 nurses, 4 respiratory therapists, and 11 instructors (trauma surgeons, emergency physicians, nurses, and intensivists) participated. Of the participants, 100% completed the survey. Satisfaction was very high, with 97.5% of the participants rating the course as "good" or "excellent" and 97.5% recommending it to others. The presurvey and postsurvey showed statistically significant improvement in attitudes toward simulation and overall CRM principles (136.3 vs. 140.3 of 170, p = 0.004) following the course, primarily in the domain of teamwork (69.1 vs. 72.0 of 85, p = 0.002). CONCLUSION: Creation of a national multidisciplinary trauma CRM curriculum is feasible, has high satisfaction among participants, and can improve attitudes toward the importance of simulation and CRM principles with the ultimate goal of improving patient safety and care.