Telepresent mechanical ventilation training versus traditional instruction: a simulation-based pilot study
critical care; education; telepresence; simulation; Health Care Sciences & Services; telementoring; mechanical ventilation; society; critical-care medicine; DASH
Background Mechanical ventilation is a complex topic that requires an in-depth understanding of the cardiopulmonary system, its associated pathophysiology and comprehensive knowledge of equipment capabilities. Introduction The use of telepresent faculty to train providers in the use of mechanical ventilation using medical simulation as a teaching methodology is not well established. The aim of this study was to compare the efficacy of telepresent faculty versus traditional in-person instruction to teach mechanical ventilation to medical students. Materials and methods Medical students for this small cohort pilot study were instructed using either in-person instruction or telementoring. Initiation and management of mechanical ventilation were reviewed. Effectiveness was evaluated by pre- and post-multiple choice tests, confidence surveys and summative simulation scenarios. Students evaluated faculty debriefing using the Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV). Results A 3-day pilot curriculum demonstrated significant improvement in the confidence (in person P<0.001; telementoring P=0.001), knowledge (in person P<0.001; telementoring P=0.022) and performance (in person P<0.001; telementoring P<0.002) of medical students in their ability to manage a critically ill patient on mechanical ventilation. Participants favoured the in-person curriculum over telepresent education, however, resultant mean DASH-SV scores rated both approaches as consistently to extremely effective. Discussion While in-person learners demonstrated larger confidence and knowledge gains than telementored learners, improvement was seen in both cases. Learners rated both methods to be effective. Technological issues may have contributed to students providing a more favourable rating of the in-person curriculum. Conclusions Telementoring is a viable option to provide medical education to medical students on the fundamentals of ventilator management at institutions that may not have content experts readily available.
Ciullo A; Yee J; Frey J A; Gothard M D; Benner A; Hammond J; Ballas D; Ahmed R A
Bmj Simulation & Technology Enhanced Learning
2019
2019-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1136/bmjstel-2017-000254" target="_blank" rel="noreferrer noopener">10.1136/bmjstel-2017-000254</a>
Noninvasive ventilation to facilitate extubation in a pediatric intensive care unit
children; face mask; General & Internal Medicine; insufficiency; intermittent; management; mechanical ventilation; nasal ventilation; positive-pressure ventilation; respiratory-failure; support
Noninvasive ventilation has been used extensively to treat chronic respiratory failure associated with neuromuscular and other restrictive thoracic diseases, and is also effective in the treatment of acute respiratory failure, allowing some patients to avoid intubation. Noninvasive positive pressure ventilation is a potentially effective way to transition selected patients off endotracheal mechanical ventilation. The authors present a retrospective chart review of pediatric patients extubated with the use of noninvasive ventilation. Extubation with noninvasive positive pressure ventilation was attempted in 25 patients. The patients had a variety of diagnoses, including neuromuscular diseases, cerebral palsy with chronic respiratory insufficiency, asthma, and acute respiratory distress syndrome (ARDS), reflecting the diversity of patients with respiratory failure seen in our pediatric intensive care unit (ICU). Indications for noninvasive ventilation-assisted extubation were chronic respiratory insufficiency, clinical evidence the patient was failing extubation, or failure of a previous attempt to extubate. Extubation was successfully facilitated in 20 of 25 patients. Of the five patients failing an initial attempt at noninvasive ventilation-assisted extubation, two required tracheostomy, two were subsequently extubated with the aid of noninvasive ventilation, and one was subsequently extubated without the use of noninvasive ventilation. Risk factors for failure to successfully extubate with the assistance of noninvasive positive pressure ventilation included the patient's inability to manage respiratory tract secretions, severe upper airway obstruction, impaired mental status, and ineffective cough with mucus plugging of the large airways. All patients had mild to moderate skin irritation due to the mask interface. No patient had any serious or long-term adverse effect of noninvasive positive pressure ventilation. All patients left the hospital alive. Noninvasive positive pressure ventilation can facilitate endotracheal extubation in pediatric patients with diverse diagnoses who have failed or who are at risk of failing extubation, including those with neuromuscular weakness.
Pope J F; Birnkrant D J
Journal of Intensive Care Medicine
2000
2000-03
Journal Article
<a href="http://doi.org/10.1046/j.1525-1489.2000.00099.x" target="_blank" rel="noreferrer noopener">10.1046/j.1525-1489.2000.00099.x</a>