Research Topic

Training in Intensive Care and Neonatal EchoCardiography (TINEC)

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Functional echocardiography (fECHO) is the bedside use of cardiac ultrasound to assess longitudinal changes in myocardial function, systemic and pulmonary blood flow, intracardiac or extracardia shunts and filling pressure. fECHO is a tool for the clinician to assess the hemodynamic condition and tissue ...

Functional echocardiography (fECHO) is the bedside use of cardiac ultrasound to assess longitudinal changes in myocardial function, systemic and pulmonary blood flow, intracardiac or extracardia shunts and filling pressure. fECHO is a tool for the clinician to assess the hemodynamic condition and tissue perfusion of sick pediatric and neonatal patients and can help determine a pathophysiological choice for cardiovascular support (inotropes, vasodilators or vasoconstrictors, diuretics, etc).

fECHO needs to be available at any time in the neonatology and pediatric intensive care unit (NICU and PICU). Clinicians performing fECHO need to develop appropriate echocardiographic theoretical and practical skills. Close cooperation with pediatric cardiology, proper logistics and training programs are mandatory to achieve a 24h a day fECHO service run by bedside clinicians.

The potential for misdiagnosis is the major issue and training and accreditation for fECHO are underdevelopped in Europe. The existing echocardiography training programms are designed to train cardiologists. The Australian Society of Ultrasound in Medicine has developped focused clinician-centered courses on point of care ultrasound for non-cardiology subspecialties and fECHO is widely used in this country. fECHO has been developping in the USA and in Europe mostly in the NICU but is still underdevelopped in the PICU.

The TINEC conference has been set up to give the basis of fECHO for neonatologists and pediatric intensivists. Assessment and monitoring of hypotension in the very low birth weight infant, of the ductus arteriosus in the premature, of response to treatment of infants with pulmonary hypertension, of the infant with perinatal asphyxia, of the pediatric or neonatal patient with sepsis or cardiovascular compromise are of upmost interest fot the bedside clinician.

The TINEC conference will provide theoretical courses on
- Basics of echocardiography :
o Principles of ultrasound
o Echo modes (2-dimensional, M-mode, pulse and continuous Doppler, color Doppler)
o Common windows and basic views
o Best echo settings
o Evaluation of pressure gradients
- Evalutaion of myocardial function
- Pulmonary hypertension :
o Evaluation of right ventricular function and pulmonary pressure
• in neonates
• after cardiac surgery
- Hemodynamic evaluation
o Cardiac output
o Shunts
o Filling pressure and fluid responsiveness
- Specific assessment for neonatologists:
o Transitional circulation
o Patent ductus arteriosus
- Specific assessment for pediatric intensivists:
o Effusion and tamponade
o Thrombus
o Extracorporeal membrane oxygenation (ECMO)
- Evaluation of diaphragmatic hernia
- Line placement under echo guidance

During the conference, practical « hands-on » workshops stations in the NICU or PICU are offered to the participants, as well as practice on a manequin. In the future, the TINEC conference should be organized every two years.


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