Mechanical Ventilation Boot Camp Curriculum

Summary

This curriculum outlines how to execute a simulation-based boot camp to teach providers how to manage mechanically ventilated patients.

Abstract

Medical management of mechanically ventilated patients is challenging to novice providers. Incorrect management of this population may lead to increased morbidity and mortality. A three-day simulation-based boot camp serves to provide one-on-one instruction with a critical care provider. These intensivists may dispense personalized immediate feedback as learners engage in hands-on practice with a real mechanical ventilator. Multiple different pathologies can be reviewed that may not be encountered in the clinical setting. Learners can visualize immediate consequences of their actions and may troubleshoot and ask questions, all while in a safe learning environment. We describe the use of human-patient simulators connected to breathing simulators and mechanical ventilators. Potential curriculum executors should be aware of the cost of the equipment and the time needed to dedicate to boot camp execution; however, this intensive interactive training has been shown to increase provider competency, knowledge, and confidence in ventilator management. This curriculum outline provides guidance on how to execute a simulation-based boot camp to train providers on the management of mechanically ventilated patients.

Introduction

This boot camp was developed to teach residents how to manage a mechanically-ventilated patient, as well as troubleshoot ventilator alarms. Management of this patient population may be intimidating to the novice practitioner who may have limited experience with critically ill patients. Teaching critical care principles at the bedside is made more difficult by national work-hour restrictions^1,2, and medicolegal concerns³ in the United States. Simulation is an effective modality to develop and refine critical care skills^4,5, as we....

Protocol

All methods described here were found to be exempt from review by the Summa Institutional Review Board.

1. Day 1 – Pre-Testing Evaluation

1. Print critical action checklists, pretest confidence surveys, pretest cognitive multiple-choice exams.
2. Place three human-patient simulators in ICU beds with the following designations: acute respiratory distress syndrome (ARDS), complete lung atelectasis secondary to mucus plugging, and pneumothorax. Set simulators in separate rooms or far enough apart that learners will not be able to easily hear the other simultaneously executed sessions. Place simulators in a dedicated learn....

Results

As noted in Yee et al, first-year residents who underwent this boot camp demonstrated significantly improved confidence, knowledge, and performance¹². Cognitive knowledge, assessed by the pre- and post-intervention multiple choice tests, increased from a mean score of 40.3% to 67.1%, with a mean change in score of +26.8% (Figure 1).

Critical actions were evaluated by.......

Discussion

The boot camp consists of three separate sessions. During the first day, learners complete a pre-testing confidence survey and medical knowledge test before undergoing a five-minute scenario. Faculty evaluate the learners using pre-determined critical actions. Leaners are then given asynchronous reading to complete before day 2. The second day is composed of the intervention stage, where groups of 2-3 learners work through five different scenarios. Faculty are at the bedside to provide immediate and personalized feedback.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Puritan Bennett 840 Ventilator	Medtronic	4-840120EMC-01	http://www.medtronic.com/covidien/en-us/products/acute-care-ventilation/puritan-bennett-pb840-ventilator.html
ASL 5000 Breathing Simulator	IngMar	31 00 117	https://www.ingmarmed.com/
Smart Stat Basic	Simulaids	101-8002	https://www.simulaids.com/product/101-8002