ABSTRACT #54

VENTILATOR TROUBLESHOOTING: A SIMULATION-BASED APPROACH TO HIGH PEAK PRESSURE ALARMS FOR CRITICAL CARE FELLOWS

Erin K. Eschbach, Jared Kutzin

PURPOSE AND GOALS: Mount Sinai Critical Care fellowships lack a dedicated curriculum on ventilator management.

Much of fellows’ learning comes from discussion at the bedside of critically ill patients. Literature from outside institutions suggests that simulation-based curriculums can improve fellows’ knowledge and comfort level with the mechanical ventilator. We sought to develop a simulation curriculum to educate critical care fellows on high-yield scenarios where proper ventilator management can improve patient outcomes.

METHODS: Two prompts were used with the SimMan3G simulator and an ASL5000 “breathing simulator.” The SimMan was intubated and attached to a Medtronic Puritan Bennett 840 Ventilator. Case 1 was a 70-year-old who presented with hypoxemic respiratory failure and was intubated prior to being sent to the ICU. Learners were asked to assess the patient given desaturation and high-pressure alarms. The participants diagnosed Acute Respiratory Distress Syndrome (ARDS) and made necessary changes to the ventilator and patient in order to improve oxygenation. The second case was a 23-year-old with severe asthma requiring intubation. High peak pressure alarms led learners to diagnose hemodynamically significant dynamic hyperinflation due to status asthmaticus. If not adjusted for expeditiously, the patient developed a tension pneumothorax requiring intervention. The objectives of these scenarios were to recognize three common causes of high peak-pressure alarms, implement recruitment maneuvers to improve hypoxemia and compliance in a patient with ARDS, and to manage critical dynamic hyperinflation in a patient with obstructive lung disease. After each scenario, a debrief was conducted using the PEARLS Healthcare Debriefing Tool.

EVALUATION PLAN: Learners were asked to do a pre-scenario and post-scenario survey. The instructor, equipment, learning environment, and content of the session were all evaluated. A five-point Likert scale was used to assess graded responses and open-ended questions were utilized to obtain qualitative data. The debrief session was utilized to determine if all educational objectives were met.

SUMMARY OF RESULTS: All four educational objectives were met in these sessions. 100% of survey responders indicated that the material learned in these sessions would be helpful to them in their practice and would help to improve patient outcomes. Separate comments indicated an appreciation for learning more about ventilator physiology and respiratory mechanics as a whole. Learners learned teamwork skills such as closed-loop communication.

REFLECTIVE

CRITIQUE:

A simulation-based ventilator curriculum is a feasible and successful way to educate learners on diagnosing and managing common etiologies of ventilator alarms. These scenarios allow learners to practice their skills on real ventilators and patients that mimic critically ill patients with high risk for respiratory decompensation in a safe environment. Given the positive feedback received, additional ventilator scenarios will be implemented.