Echocardiography

Stanford Critical Care Medicine has a long and extensive history in training fellows and residents in bedside echocardiography and ultrasound for critically ill patients.  In 2009, Dr. Anne-Sophie Beraud enhanced the training through implementation of bedside training, simulation training, focused individual feedback for acquired images, and online resources..  Dr. Beraud and Dr. Sara Nikravan developed a self-directed online training course for Anesthesia, Internal Medicine, and Emergency Medicine trainees.  This course is now available online through Stanford Lagunitas.  The course will lead you through the core concepts of ultrasound physics, transthoracic echocardiography, lung ultrasound, and measurement techniques. 

Dr. Vidya Rao became the Director of Point of Care Ultrasound for the Department of Anesthesiology, Perioperative, and Pain Medicine in 2017.  Through her leadership, the Critical Care Ultrasound Training curriculum for CCM fellows has continued to grow.  She is joined by a group of core faculty dedicated to state-of-the art ultrasound training for our fellows.  These faculty include Dr. Paul Mohabir, Dr. Jenny Wilson, Dr. Yoshi Mitarai, Dr. Fred Mihm, Dr. Javier Lorenzo, Dr. Marianne Chen and Dr. Erin Hennessey

The formal ultrasound and echocardiography training for our fellows encompasses formal training in TTE as well as TEE, non-cardiac applications (FAST exam, lung, abdominal, DVT and ocular ultrasound) of ultrasound in the ICU, as well as ultrasound-guided vascular access.

Training in transthoracic echocardiography for critically ill patients takes place over the entirety of the fellowship program in order to provide a longitudinal learning experience.  All fellows spend one week of intensive training in TTE during the first two months of fellowship.  The week incorporates simulation training, one-on-one bedside scanning with attending physicians, in addition to one-on-one bedside training with the echocardiography ultrasonographer technicians.  Each fellow is expected to review all images during this one-week training.  The week concludes with a one-on-one review session with Dr. Rao to review all images obtained.  This bootcamp week prepares fellows to use critical care ultrasound to assist in the bedside assessment of critically ill patients in order to quickly assess volume status (e.g. inferior venal caval diameter) and to identify cardiac tamponade, cardiac function (e.g. significant wall motion abnormalities) and major valve dysfunction.

Many fellows choose to complete an elective in Advanced Echocardiography and Critical Care Ultrasound.  This elective incorporates advanced transthoracic echocardiography techniques, training in transesophageal echocardiography, and involvement and participation in the many ultrasound and echocardiography research studies conducted at Stanford and our affiliate sites.  During this elective the fellow is encouraged to attend reading review sessions hosted by the Cardiac Anesthesia Division and the monthly ECHO rounds didactic.  Fellow are encouraged to record all studies and document all studies throughout fellowship training in MedHub.  All fellows trained to reach competency at the advanced level by the end of their training.  The recommended studies for competency in critical care ultrasound training are listed below and are adapted from SCCM, SOCCA, and Stanford CCM guidelines.

 PROCEDURE PERFORMED REVIEWED REQUIRED AT STANFORD
Focused Bedside TTE 50 50 X
Vascular Ultrasound DVT 10 10 X
Vascular Ultrasound (Access) 10   X
Abdominal Ultrasound 30 30 X
Ocular Ultrasound 10 10 X
Lung and Pleural Ultrasound 10 10 X
Focused Bedside TEE 50 50 *encouraged