Critical care ultrasound among Tunisian intensive care residents: A Cross-sectional Survey


Iyed Maatouk
Amani Maatouk
Hassen Ben Ghezala
Lamia Ouanes Besbes


Introduction: Critical Care ultrasound (CCUS) is more and more used in Tunisian critical care units. An objective assessment of this training has not yet been performed.

Aim: To assess the theoretical and practical knowledge about CCUS among Intensive Care Unit (ICU) residents.

Methods: This is a cross-sectional study conducted during the period from January to June 2021. Data were collected using a French language questionnaire distributed on the day of the selection of the residents' posts for the next training period (at the end of June 2021).

Results: Out of 75 residents, 37 accepted to answer to the survey (Participation rate =49 %). The majority were female (66.4%). The mean age was 29±12.36 years. Only 5.4% of participants (n=2) had previously received training concerning echocardiography and only 8.1% of the participants have received dedicated training for lung ultrasound (LU). Among the participants, 80.1% of residents (n=30) had never performed a transthoracic echocardiography (TTE). Competence in performing echocardiography was self-assessed quite good and bad by 5.4% and 43.2% of responders respectively. Most of the residents (86%) did not insert before ultrasound-guided central venous catheters.

Views known by the participants using TTE were mainly parasternal long axis section (56.8%) and apical 4/5 chambers section (52.8%). All participants (100%) thought that teaching CCU is a necessary part of the training of intensivists.

Conclusion: Our study highlighted the lack of training of Tunisian ICU residents regarding CCUS learning. Therefore, it is crucial to integrate such learning and training into their training programs.


ultrasound, intensive care unit, resident, learning, survey



  1. Mill JS. Pour l’Association des urgentistes et réanimateurs intéressés par l’ultrasono- graphie (AURUS). Rev. Médicale Suisse 2009;3.
  2. Kobal SL, Atar S, Siegel RJ. Hand-carried ultrasound improves the bedside cardiovascular examination. Chest 2004;126:693–701.
  3. Romero-Bermejo FJ, Ruiz-Bailén M, Guerrero-De-Mier M, López-Álvaro J. Echocardiographic Hemodynamic Monitoring in the Critically Ill Patient. Curr. Cardiol. Rev. 2011;7:146–56.
  4. Vignon P, Dugard A, Abraham J, Belcour D, Gondran G, Pepino F, et al. Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit. Intensive Care Med. 2007;33:1795–9.
  5. Expert Round Table on Echocardiography in ICU. International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med. 2014;40:654–66.
  6. Mayo PH, Maury E. Echography is mandatory for the initial management of critically ill patients: We are not sure. Intensive Care Med. 2014;40:1760–2.
  7. Huang SJ, McLean AS. Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective. Crit. Care Lond. Engl. 2010;14:313.
  8. Critical Care Ultrasound: A Systematic Review of Internation... : Critical Care Medicine [Internet]. 2023 [cited 2023 Aug 16];Available from:
  9. Price S, Via G, Sloth E, Guarracino F, Breitkreutz R, Catena E, et al. 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.
  10. Vignon P. Formation des réanimateurs à l’échographie cardiaque. Réanimation 2004;13:126–30.
  11. Karakitsos D, Labropoulos N, De Groot E, Patrianakos AP, Kouraklis G, Poularas J, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit. Care Lond. Engl. 2006;10:R162.
  12. Slama M, Novara A, Safavian A, Ossart M, Safar M, Fagon JY. Improvement of internal jugular vein cannulation using an ultrasound-guided technique. Intensive Care Med. 1997;23:916–9.
  13. Saqqur M, Zygun D, Demchuk A. Role of transcranial Doppler in neurocritical care. Crit. Care Med. 2007;35:S216-223.
  14. Ollerton JE, Sugrue M, Balogh Z, D’Amours SK, Giles A, Wyllie P. Prospective study to evaluate the influence of FAST on trauma patient management. J. Trauma 2006;60:785–91.
  15. Bentzinger P, Mahoudeau G, Alezrah M, Pottecher T. Enquête sur l’apprentissage de l’échographie par les internes d’anesthésie-réanimation de l’inter-région Est. Ann. Fr. Anesth. Réanimation 2013;32:246–50.
  16. Barsuk JH, McGaghie WC, Cohen ER, O’Leary KJ, Wayne DB. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit *. Crit. Care Med. 2009;37:2697–701.
  17. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients - PubMed [Internet]. 2023 [cited 2023 Aug 16];Available from:
  18. Clinical review: Bedside lung ultrasound in critical care practice - PubMed [Internet]. 2023 [cited 2023 Sep 2];Available from:
  19. Manasia AR, Nagaraj HM, Kodali RB, Croft LB, Oropello JM, Kohli-Seth R, et al. Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients. J. Cardiothorac. Vasc. Anesth. 2005;19:155–9.
  20. Basic critical care echocardiography: validation of a curriculum dedicated to noncardiologist residents - PubMed [Internet]. 2023 [cited 2023 Aug 16];Available from:
  21. Sidhu HS, Olubaniyi BO, Bhatnagar G, Shuen V, Dubbins P. Role of Simulation-Based Education in Ultrasound Practice Training. J. Ultrasound Med. 2012;31:785–91.
  22. McSparron JI, Michaud GC, Gordan PL, Channick CL, Wahidi MM, Yarmus LB, et al. Simulation for Skills-based Education in Pulmonary and Critical Care Medicine. Ann. Am. Thorac. Soc. 2015;12:579–86.
  23. Sharma V, Fletcher SN. A review of echocardiography in anaesthetic and peri-operative practice. Part 2: training and accreditation. Anaesthesia 2014;69:919–27.