1
|
Carvey MMT, Omidvar AA, Wan EE, Hynes AM, Lentz SA. Effectiveness of the Introduction to Critical Care in Emergency Medicine Curriculum's Implementation Among Trainees Interested in Intensive Care. J Emerg Med 2024; 67:e80-e88. [PMID: 38806349 DOI: 10.1016/j.jemermed.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/11/2024] [Accepted: 03/06/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Emergency physicians and trainees provide the initial care for critically ill patients. In times of emergency department boarding, this care may extend beyond the first few hours. To meet the needs of this population, a standardized novel critical care curriculum targeting third- and fourth-year medical students was developed. OBJECTIVES We hypothesized that the institution of such a curriculum is feasible and will provide an increased understanding of the underlying critical care principles within this learner population. METHODS We developed a 2-month-long critical care curriculum (February-April) and carried out the course twice from 2022-2023. Our pilot study deployed this curriculum to medical students interested in critical care through the American Academy of Emergency Medicine/Resident and Student Association. The primary outcome included was the overall composite score comparison of the pre- and post-course evaluations, with a higher score indicating that the student improved their comprehension. Secondary outcomes included the individual factors of the pre- and post-course surveys. RESULTS Fifty-one trainees completed the pilot course, including 11/51 (21.6%) third-year medical students and 40/51 (78.4%) fourth-year medical students. Overall, 39 had "no experience" in critical care and 12 indicated that they had "previous experience." The students' baseline pre-course from the pooled 2022 and 2023 Introduction to Critical Care in Emergency Medicine (ICCEM) curriculum data was 3 (interquartile range 4-3) and their post-course score was 9 (interquartile range 9-9), p-value 0.015 for the 51/54 students who completed the course. CONCLUSIONS The novel curriculum was found to be effective during its implementation in third- and fourth-year medical students. As such, it indicated that a critical care fundamentals course improves confidence in these topics for students with and without prior experience. Further work is necessary to understand the generalizability and knowledge retention of the proposed pilot curriculum.
Collapse
Affiliation(s)
- Matthew M T Carvey
- Department of Emergency Medicine, MetroHealth/Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ava A Omidvar
- St. George's University, School of Medicine, St. George, Grenada
| | - Elias E Wan
- Department of Surgery, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Allyson M Hynes
- Department of Emergency Medicine; Department of Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Skyler A Lentz
- Department of Emergency Medicine and Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| |
Collapse
|
2
|
Ward J, Noel C. Basic Modes of Mechanical Ventilation. Emerg Med Clin North Am 2022; 40:473-488. [DOI: 10.1016/j.emc.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
3
|
Rodríguez-Llamazares S, Arroyo-Hernández LJ, Hernández-Cárdenas CM. Mechanical Ventilation Education for All: Call for Action. Chest 2021; 159:38-39. [PMID: 33422205 PMCID: PMC7837023 DOI: 10.1016/j.chest.2020.09.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022] Open
|
4
|
Emergency Department Management of Severe Hypoxemic Respiratory Failure in Adults With COVID-19. J Emerg Med 2020; 60:729-742. [PMID: 33526308 PMCID: PMC7836534 DOI: 10.1016/j.jemermed.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/14/2020] [Accepted: 12/13/2020] [Indexed: 01/19/2023]
Abstract
Background While emergency physicians are familiar with the management of hypoxemic respiratory failure, management of mechanical ventilation and advanced therapies for oxygenation in the emergency department have become essential during the coronavirus disease 2019 (COVID-19) pandemic. Objective We review the current evidence on hypoxemia in COVID-19 and place it in the context of known evidence-based management of hypoxemic respiratory failure in the emergency department. Discussion COVID-19 causes mortality primarily through the development of acute respiratory distress syndrome (ARDS), with hypoxemia arising from shunt, a mismatch of ventilation and perfusion. Management of patients developing ARDS should focus on mitigating derecruitment and avoiding volutrauma or barotrauma. Conclusions High flow nasal cannula and noninvasive positive pressure ventilation have a more limited role in COVID-19 because of the risk of aerosolization and minimal benefit in severe cases, but can be considered. Stable patients who can tolerate repositioning should be placed in a prone position while awake. Once intubated, patients should be managed with ventilation strategies appropriate for ARDS, including targeting lung-protective volumes and low pressures. Increasing positive end-expiratory pressure can be beneficial. Inhaled pulmonary vasodilators do not decrease mortality but may be given to improve refractory hypoxemia. Prone positioning of intubated patients is associated with a mortality reduction in ARDS and can be considered for patients with persistent hypoxemia. Neuromuscular blockade should also be administered in patients who remain dyssynchronous with the ventilator despite adequate sedation. Finally, patients with refractory severe hypoxemic respiratory failure in COVID-19 should be considered for venovenous extracorporeal membrane oxygenation.
Collapse
|
5
|
Schroedl CJ, Frogameni A, Barsuk JH, Cohen ER, Sivarajan L, Wayne DB. Impact of Simulation-based Mastery Learning on Resident Skill Managing Mechanical Ventilators. ATS Sch 2020; 2:34-48. [PMID: 33870322 PMCID: PMC8043263 DOI: 10.34197/ats-scholar.2020-0023oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Caring for patients requiring mechanical ventilation is complex, and residents may lack adequate skill for managing these patients. Simulation-based mastery learning (SBML) is an educational model that trains clinicians to a high standard and can reduce complications. The mastery learning model has not been applied to ventilator management. Objective: The purpose of this study was to determine whether SBML, as compared with traditional training, is an effective strategy for teaching residents the skills necessary to manage patients requiring mechanical ventilation. Methods: We developed an SBML curriculum and a 47-item skills checklist to test ventilator management for patients with normal, restricted, and obstructed lung physiology. A minimum passing standard (MPS) on the checklist was set using the Mastery Angoff method. Residents rotating through the medical intensive care unit in Academic Year 2017-2018 were assigned to SBML or traditional training based on their medical intensive care unit team. The SBML group was pretested on a ventilator simulator using the skills checklist. They then received a 1.5-hour session (45 min didactic and 45 min deliberate practice on the simulator with feedback). At rotation completion, they were posttested on the simulator using the checklist until the MPS was met. Both SBML-trained and traditionally trained groups received teaching during daily bedside rounds and twice weekly didactic lectures. At rotation completion, traditionally trained residents were tested using the same skills checklist on the simulator. We compared pretest and posttest performance among SBML-trained residents and end of the rotation test performances between the SBML-trained and traditionally trained residents. Results: The MPS was set at 87% on the checklist. Fifty-seven residents were assigned to the SBML-trained group and 49 were assigned to the traditionally trained group. Mean checklist scores for SBML-trained residents improved from 51.4% (standard deviation [SD] = 17.5%) at pretest to 86.1% (SD = 7.6%) at initial posttest and 92.5% (SD = 3.7%) at final (mastery) posttest (both P < 0.001). Forty-two percent of residents required more than one attempt at the posttest to meet or exceed the MPS. At rotation completion, the traditionally trained residents had a mean test score of 60.9% (SD = 13.3%). Conclusion: SBML is an effective strategy to train residents on mechanical ventilator management. An SBML curriculum may augment traditional training methods to further equip residents to safely manage ventilated patients.
Collapse
Affiliation(s)
- Clara J. Schroedl
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexandra Frogameni
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine R. Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lakshmi Sivarajan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane B. Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
6
|
Abstract
Background: Management of mechanical ventilation (MV) is a curricular milestone for trainees in pulmonary critical care medicine (PCCM) and critical care medicine (CCM) fellowships. Though recognition of ventilator waveform abnormalities that could result in patient complications is an important part of management, it is unclear how well fellows recognize these abnormalities. Objective: To study proficiency of ventilator waveform analysis among first-year fellows enrolled in a MV course compared with that of traditionally trained fellows. Methods: The study took place from July 2016 to January 2019, with 93 fellows from 10 fellowship programs completing the waveform examination. Seventy-three fellows participated in a course during their first year of fellowship, with part I occurring at the beginning of fellowship in July and part II occurring after 6 months of clinical work. These fellows were given a five-question ventilator waveform examination at multiple time points throughout the two-part course. Twenty fellows from three other fellowship programs who were in their first, second, or third year of fellowship and who did not participate in this course served as the control group. These fellows took the waveform examination a single time, at a median of 23 months into their training. Results: Before the course, scores were low but improved after 3 days of education at the beginning of the fellowship (18.0 ± 1.6 vs. 45.6 ± 3.0; P < 0.0001). Scores decreased after 6 months of clinical rotations but increased to their highest levels after part II of the course (33.7 ± 3.1 for part II pretest vs. 77.4 ± 2.4 for part II posttest; P < 0.0001). After completing part I at the beginning of fellowship, fellows participating in the course outperformed control fellows, who received a median of 23 months of traditional fellowship training at the time of testing (45.6 ± 3.0 vs. 25.3 ± 2.7; P < 0.0001). There was no difference in scores between PCCM and CCM fellows. In anonymous surveys, the fellows also rated the mechanical ventilator lectures highly. Conclusion: PCCM and CCM fellows do not recognize common waveform abnormalities at the beginning of fellowship but can be trained to do so. Traditional fellowship training may be insufficient to master ventilator waveform analysis, and a more intentional, structured course for MV may help fellowship programs meet the curricular milestones for MV.
Collapse
|
7
|
Byars DV, Klinkhammer MD, Fellin MA. In Situ Simulation for Ventilator Management in Emergency Medicine. AEM EDUCATION AND TRAINING 2020; 4:415-418. [PMID: 33150285 PMCID: PMC7592812 DOI: 10.1002/aet2.10417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/10/2019] [Accepted: 11/13/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Emergency physicians have a residency graduation milestone to effectively manage the airway and initiate mechanical ventilation. However, many emergency medicine (EM) residents report rarely or never feeling comfortable managing mechanically ventilated patients. Our goal was to determine the effectiveness of an in situ simulation program for EM residents to successfully manage a ventilator on a high-fidelity patient simulator. METHODS This was a prospective observational educational study of EM residents executed in four steps. Baseline performance was assessed by observed standard clinical examination (OSCE) in a checklist manner after our routine classroom-based annual ventilator teaching. The in situ simulation was executed in a small-group format located in the trauma bay of the ED using only equipment available in the clinical setting. Performance at 1 week and 8 months after the educational intervention was assessed by repeat OSCE. The results were assessed using paired Student's t-tests. RESULTS There was a statistically significant improvement in all checklist markers of successful ventilator management on repeat OSCE after the in situ simulation intervention. A final unannounced retention OSCE was administered 8 months after the intervention with no additional interval training. The improved performance persisted 8 months later. CONCLUSIONS This in situ simulation study demonstrated improved checklist scoring on ventilator management in simulated critically ill patients by EM residents. This improvement persisted 8 months after the educational intervention.
Collapse
|
8
|
Online Learning and Residents' Acquisition of Mechanical Ventilation Knowledge: Sequencing Matters. Crit Care Med 2020; 48:e1-e8. [PMID: 31688194 DOI: 10.1097/ccm.0000000000004071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Rapid advancements in medicine and changing standards in medical education require new, efficient educational strategies. We investigated whether an online intervention could increase residents' knowledge and improve knowledge retention in mechanical ventilation when compared with a clinical rotation and whether the timing of intervention had an impact on overall knowledge gains. DESIGN A prospective, interventional crossover study conducted from October 2015 to December 2017. SETTING Multicenter study conducted in 33 PICUs across eight countries. SUBJECTS Pediatric categorical residents rotating through the PICU for the first time. We allocated 483 residents into two arms based on rotation date to use an online intervention either before or after the clinical rotation. INTERVENTIONS Residents completed an online virtual mechanical ventilation simulator either before or after a 1-month clinical rotation with a 2-month period between interventions. MEASUREMENTS AND MAIN RESULTS Performance on case-based, multiple-choice question tests before and after each intervention was used to quantify knowledge gains and knowledge retention. Initial knowledge gains in residents who completed the online intervention (average knowledge gain, 6.9%; SD, 18.2) were noninferior compared with those who completed 1 month of a clinical rotation (average knowledge gain, 6.1%; SD, 18.9; difference, 0.8%; 95% CI, -5.05 to 6.47; p = 0.81). Knowledge retention was greater following completion of the online intervention when compared with the clinical rotation when controlling for time (difference, 7.6%; 95% CI, 0.7-14.5; p = 0.03). When the online intervention was sequenced before (average knowledge gain, 14.6%; SD, 15.4) rather than after (average knowledge gain, 7.0%; SD, 19.1) the clinical rotation, residents had superior overall knowledge acquisition (difference, 7.6%; 95% CI, 2.01-12.97;p = 0.008). CONCLUSIONS Incorporating an interactive online educational intervention prior to a clinical rotation may offer a strategy to prime learners for the upcoming rotation, augmenting clinical learning in graduate medical education.
Collapse
|
9
|
Foley TM, Philpot BA, Davis AS, Swanson MB, Harland KK, Kuhn JD, Fuller BM, Mohr NM. Implementation of an ED-based bundled mechanical ventilation protocol improves adherence to lung-protective ventilation. Am J Emerg Med 2020; 43:186-194. [PMID: 32139215 PMCID: PMC7483340 DOI: 10.1016/j.ajem.2020.02.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tyler M Foley
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America.
| | - Brittany A Philpot
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | - Alysa S Davis
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | - Morgan B Swanson
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | - Justin D Kuhn
- Department of Respiratory Care, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | - Brian M Fuller
- Division of Emergency Medicine, Department of Anesthesiology, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO, United States of America
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| |
Collapse
|
10
|
Zyblewski SC, Callow L, Beke DM, Jain P, Madathil SB, Schwartz S, Tabbutt S, Bronicki RA. Education and Training in Pediatric Cardiac Critical Care: International Perspectives. World J Pediatr Congenit Heart Surg 2019; 10:769-777. [PMID: 31663839 DOI: 10.1177/2150135119881369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pediatric cardiac intensive care is an evolving and maturing field. There have been advances in education and training in recent years, specifically progress toward standardization of curricula, competencies, and certifications. International partnerships have fostered similar advancements in less resourced countries. For all disciplines and levels of expertise, simulation remains a versatile and effective modality in education. Although there is improved standardization for the training of physicians and nurses, the certification process remains undetermined.
Collapse
Affiliation(s)
- Sinai C Zyblewski
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Louise Callow
- Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Dorothy M Beke
- Cardiac Intensive Care, Boston Children's Hospital, Boston, MA, USA
| | - Parag Jain
- Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | - Steven Schwartz
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Tabbutt
- Division of Critical Care Medicine, Benioff Children's Hospital, University of California, San Francisco, CA, USA
| | - Ronald A Bronicki
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Wardi G, Joel I, Villar J, Lava M, Gross E, Tolia V, Seethala RR, Owens RL, Sell RE, Montesi SB, Rahaghi FN, Bose S, Rai A, Stevenson EK, McSparron J, Tolia V, Beitler JR. Equipoise in Appropriate Initial Volume Resuscitation for Patients in Septic Shock With Heart Failure: Results of a Multicenter Clinician Survey. J Intensive Care Med 2019; 35:1338-1345. [PMID: 31446829 DOI: 10.1177/0885066619871247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE International clinical practice guidelines call for initial volume resuscitation of at least 30 mL/kg body weight for patients with sepsis-induced hypotension or shock. Although not considered in the guidelines, preexisting cardiac dysfunction may be an important factor clinicians weigh in deciding the quantity of volume resuscitation for patients with septic shock. METHODS We conducted a multicenter survey of clinicians who routinely treat patients with sepsis to evaluate their beliefs, behaviors, knowledge, and perceived structural barriers regarding initial volume resuscitation for patients with sepsis and concomitant heart failure with reduced ejection fraction (HFrEF) <40%. Initial volume resuscitation preferences were captured as ordinal values, and additional testing for volume resuscitation preferences was performed using McNemar and Wilcoxon signed rank tests as indicated. Univariable logistic regression models were used to identify significant predictors of ≥30 mL/kg fluid administration. RESULTS A total of 317 clinicians at 9 US hospitals completed the survey (response rate 47.3%). Most respondents were specialists in either internal medicine or emergency medicine. Substantial heterogeneity was found regarding sepsis resuscitation preferences for patients with concomitant HFrEF. The belief that patients with septic shock and HFrEF should be exempt from current sepsis bundle initiatives was shared by 39.4% of respondents. A minimum fluid challenge of ∼30 mL/kg or more was deemed appropriate in septic shock by only 56.4% of respondents for patients with concomitant HFrEF, compared to 89.1% of respondents for patients without HFrEF (P < .01). Emergency medicine physicians were most likely to feel that <30 mL/kg was most appropriate in patients with septic shock and HFrEF. CONCLUSIONS Clinical equipoise exists regarding initial volume resuscitation for patients with sepsis-induced hypotension or shock and concomitant HFrEF. Future studies and clinical practice guidelines should explicitly address resuscitation in this subpopulation.
Collapse
Affiliation(s)
- Gabriel Wardi
- Department of Emergency Medicine, 8784University of California, San Diego, CA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, 8784University of California, San Diego, CA, USA
| | - Ian Joel
- Division of Pulmonary, Critical Care, and Sleep Medicine, 8784University of California, San Diego, CA, USA
| | - Julian Villar
- Department of Emergency Medicine, Kaiser Oakland, CA, USA
| | - Michael Lava
- 194441Wellstar Medical Group Pulmonary Medicine, Marietta, GA, USA
| | - Eric Gross
- Department of Emergency Medicine, 8784University of California, Davis, CA, USA
| | - Vaishal Tolia
- Department of Emergency Medicine, 8784University of California, San Diego, CA, USA
| | - Raghu R Seethala
- Department of Emergency Medicine, 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert L Owens
- Division of Pulmonary, Critical Care, and Sleep Medicine, 8784University of California, San Diego, CA, USA
| | - Rebecca E Sell
- Division of Pulmonary, Critical Care, and Sleep Medicine, 8784University of California, San Diego, CA, USA
| | - Sydney B Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Somnath Bose
- Department of Anesthesia, Critical Care, and Pain Medicine, 1859Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashish Rai
- Department of Pulmonary, Critical Care, and Sleep Medicine, 25218North Shore Medical Center, MA, USA
| | - Elizabeth K Stevenson
- Department of Pulmonary, Critical Care, and Sleep Medicine, 25218North Shore Medical Center, MA, USA
| | - Jakob McSparron
- Division of Pulmonary and Critical Care Medicine, 1259University of Michigan, Ann Arbor, MI, USA
| | - Vaishal Tolia
- Department of Emergency Medicine, 8784University of California, San Diego, CA, USA
| | - Jeremy R Beitler
- Center for Acute Respiratory Failure and Division of Pulmonary, Allergy, and Critical Care Medicine, 5798Columbia University, New York, NY
| |
Collapse
|
12
|
Keller JM. Mechanical Ventilation Training During Graduate Medical Education: Perspectives and Review of the Literature. J Grad Med Educ 2019; 11:389-401. [PMID: 31440332 PMCID: PMC6699526 DOI: 10.4300/jgme-d-18-00828.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/04/2019] [Accepted: 04/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Management of mechanical ventilation (MV) is an important and complex aspect of caring for critically ill patients. Management strategies and technical operation of the ventilator are key skills for physicians in training, as lack of expertise can lead to substantial patient harm. OBJECTIVE We performed a narrative review of the literature describing MV education in graduate medical education (GME) and identified best practices for training and assessment methods. METHODS We searched MEDLINE, PubMed, and Google Scholar for English-language, peer-reviewed articles describing MV education and assessment. We included articles from 2000 through July 2018 pertaining to MV education or training in GME. RESULTS Fifteen articles met inclusion criteria. Studies related to MV training in anesthesiology, emergency medicine, general surgery, and internal medicine residency programs, as well as subspecialty training in critical care medicine, pediatric critical care medicine, and pulmonary and critical care medicine. Nearly half of trainees assessed were dissatisfied with their MV education. Six studies evaluated educational interventions, all employing simulation as an educational strategy, although there was considerable heterogeneity in content. Most outcomes were assessed with multiple-choice knowledge testing; only 2 studies evaluated the care of actual patients after an educational intervention. CONCLUSIONS There is a paucity of information describing MV education in GME. The available literature demonstrates that trainees are generally dissatisfied with MV training. Best practices include establishing MV-specific learning objectives and incorporating simulation. Next research steps include developing competency standards and validity evidence for assessment tools that can be utilized across MV educational curricula.
Collapse
|
13
|
The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients. J Crit Care 2019; 52:40-47. [PMID: 30954692 DOI: 10.1016/j.jcrc.2019.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/16/2019] [Accepted: 03/21/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To measure effects of ED crowding on lung-protective ventilation (LPV) utilization in critically ill ED patients. METHODS This is a retrospective cohort study of adult mechanically ventilated ED patients admitted to the medical intensive care unit (MICU), over a 3.5-year period at a single academic tertiary care hospital. Clinical data, including reason for intubation, severity of illness (MPM0-III), acute respiratory distress syndrome (ARDS) risk score (EDLIPS), and ventilator settings were extracted via electronic query of electronic health record and standardized chart abstraction. Crowding metrics were obtained at 5-min intervals and averaged over the ED stay, stratified by acuity and disposition. Multivariate logistic regression was used to predict likelihood of LPV prior to ED departure. RESULTS Mechanical ventilation was used in 446 patients for a median ED duration of 3.7 h (interquartile ratio, IQR, 2.3, 5.6). Mean MPM0-III score was 32.5 ± 22.7, with high risk for ARDS (EDLIPS ≥5) seen in 373 (82%) patients. Initial and final ED ventilator settings differed in 134 (30.0%) patients, of which only 47 (35.1%) involved tidal volume changes. Higher percentages of active ED patients (workup in-progress) and those requiring eventual admission were associated with lower odds of LPV utilization by ED departure (OR 0.97, 95%CI 0.94-1.00; OR 0.97, 95%CI 0.94-1.00, respectively). In periods of high volume, ventilator adjustments to settings other than the tidal volume were associated with higher odds of LPV utilization. Reason for intubation, MPM0-III, and EDLIPS were not associated with LPV utilization, with no interactions detected in times of crowding. CONCLUSIONS ED patients remain on suboptimal tidal volume settings with infrequent ventilator adjustments during the ED stay. Hospitals should focus on both systemic factors and bedside physician and/or respiratory therapist interventions to increase LPV utilization in times of ED boarding and crowding for all patients.
Collapse
|
14
|
Zisk-Rony RY, Weissman C, Weiss YG. Mechanical ventilation patterns and trends over 20 years in an Israeli hospital system: policy ramifications. Isr J Health Policy Res 2019; 8:20. [PMID: 30709421 PMCID: PMC6357444 DOI: 10.1186/s13584-019-0291-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/18/2019] [Indexed: 11/27/2022] Open
Abstract
Background Mechanical ventilation is a life supporting modality increasingly utilized when caring for severely ill patients. Its increasing use has extended the survival of the critically ill leading to increasing healthcare expenditures. We examined changes in the hospital-wide use of mechanical ventilation over 20 years (1997–2016) in two Israeli hospitals to determine whether there were specific patterns (e.g. seasonality, weekday vs. weekend) and trends (e.g. increases or decreases) among various hospital departments and units. Methods Retrospective analysis of prospectively collected data on all mechanically ventilated patients over 20-years in a two-hospital Israeli medical system was performed. Data were collected for each hospital unit caring for ventilated patients. Time-series analysis examined short and long-term trends, seasonality and intra-week variation. Results Over two decades overall ventilator-days increased from 11,164 (31 patients/day) in 1997 to 24,317 (67 patients/day) in 2016 mainly due to more patients ventilated on internal medicine wards (1997: 4 patients/day; 2016: 24 patients/day). The increases in other hospital areas did not approach the magnitude of the internal medicine wards increases. Ventilation on wards reflected the insufficient number of ICU beds in Israel. A detailed snapshot over 4 months of patients ventilated on internal medicine wards (n = 745) showed that they tended to be elderly (median age 75 years) and that 24% were ventilated for more than a week. Hospital-wide ventilation patterns were the weighted sum of the various individual patient units with the most noticeable pattern being peak winter prevalence on the internal medical wards and in the emergency department. This seasonality is not surprising, given the greater incidence of respiratory ailments in winter. Conclusions Increased mechanical ventilation plus seasonality have budgetary, operational and staffing consequences for individual hospitals and the entire healthcare system. The Israeli healthcare leadership needs to plan and support expanding, equipping and staffing acute and chronic care units that are staffed by providers trained to care for such complex patients. Electronic supplementary material The online version of this article (10.1186/s13584-019-0291-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Charles Weissman
- Department of Anesthesiology and Critical Care Medicine, Respiratory Care Service and Hospital Administration, Hadassah-Hebrew University Medical Center, Hebrew University-Hadassah School of Medicine, Kiryat Hadassah POB 12000, 91120, Jerusalem, Israel.
| | - Yoram G Weiss
- Department of Anesthesiology and Critical Care Medicine, Respiratory Care Service and Hospital Administration, Hadassah-Hebrew University Medical Center, Hebrew University-Hadassah School of Medicine, Kiryat Hadassah POB 12000, 91120, Jerusalem, Israel
| |
Collapse
|
15
|
Tallo FS, Abib SDCV, Baitello AL, Lopes RD. Development and validation of a questionnaire to assess the knowledge of mechanical ventilation in urgent care among students in their last-year medical course in Brazil. Clinics (Sao Paulo) 2019; 74:e663. [PMID: 31644664 PMCID: PMC6794956 DOI: 10.6061/clinics/2019/e663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 07/17/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To develop and validate a questionnaire to assess the knowledge of mechanical ventilation among final-year medical students in Brazil. METHODS A cross-sectional study conducted between October 2015 and October 2017 involving 554 medical students was carried out to develop a questionnaire for assessing knowledge on mechanical ventilation. Reproducibility was evaluated with the intraclass correlation coefficient, internal consistency was evaluated with Cronbach's alpha, and construct validation was evaluated with a tetrachoric exploratory factor analysis. To compare the means of the competences among the same type of assessment tool, the nonparametric Friedman test was used, and the identification of the differences was obtained with Dunn-Bonferroni tests. RESULTS The final version of the questionnaire contained 19 questions. The instrument presented a clarity index of 8.94±0.83. The value of the intraclass correlation coefficient was 0.929, and Cronbach's alpha was 0.831. The factor analysis revealed five factors associated with knowledge areas regarding mechanical ventilation. The final score among participants was 24.05%. CONCLUSION The instrument has a satisfactory clarity index and adequate psychometric properties and can be used to assess the knowledge of mechanical ventilation among final-year medical students in Brazil.
Collapse
Affiliation(s)
- Fernando Sabia Tallo
- Departamento de Cirurgia, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | | | | | - Renato Delascio Lopes
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, US
| |
Collapse
|
16
|
Al-Otaibi H. Evaluation of critical care providers' knowledge in basic mechanical ventilation management: An opportunity for improvement. SAUDI JOURNAL FOR HEALTH SCIENCES 2019. [DOI: 10.4103/sjhs.sjhs_130_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
17
|
Aurora ME, Kopek K, Weiner GM, Donn SM. Basics of Infant Conventional Mechanical Ventilation: An Interactive Animated Teaching Module. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10658. [PMID: 30800859 PMCID: PMC6338144 DOI: 10.15766/mep_2374-8265.10658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/30/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION While conventional mechanical ventilation is a common therapy in the neonatal intensive care unit (NICU), pediatric residents receive insufficient instruction. This stand-alone computer module provides an interactive method of learning basic infant pulmonary physiology and principles of mechanical ventilation. METHODS This module runs offline and is compatible with a variety of operating systems. Participants complete a six-question, case-based pretest. The seven-section instructional module is self-paced, narrated, animated, and interactive. Learners can repeat each section as needed. At the conclusion of the module, participants complete the same six-question test and receive feedback. In total, the module requires 15-20 minutes to complete. RESULTS The curriculum has been implemented at the beginning of the NICU rotation over a 2-year period within our pediatric residency program. Participants preferred this interactive module and had higher posttest scores when compared to a PowerPoint presentation. After 4 months, there was evidence of knowledge decay. DISCUSSION The interactive module is enjoyable, effective, and convenient. It engages participants in active learning and allows them to control the time and pace of their instruction. We have implemented the curriculum within our residency program and believe it would be useful for a variety of NICU health care providers.
Collapse
Affiliation(s)
- Megan E. Aurora
- Fellow in Pediatrics and Communicable Diseases, Division of Neonatal and Perinatal Medicine, University of Michigan Medical School
| | - Kristinna Kopek
- Instructional Designer, Health Information Technology and Services, University of Michigan Medical School
| | - Gary M. Weiner
- Clinical Associate Professor of Pediatrics and Communicable Diseases, Division of Neonatal and Perinatal Medicine, University of Michigan Medical School
| | - Steven M. Donn
- Professor of Pediatrics and Communicable Diseases, Division of Neonatal and Perinatal Medicine, University of Michigan Medical School
| |
Collapse
|
18
|
Angotti LB, Richards JB, Fisher DF, Sankoff JD, Seigel TA, Al Ashry HS, Wilcox SR. Duration of Mechanical Ventilation in the Emergency Department. West J Emerg Med 2017; 18:972-979. [PMID: 28874952 PMCID: PMC5576636 DOI: 10.5811/westjem.2017.5.34099] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Due to hospital crowding, mechanically ventilated patients are increasingly spending hours boarding in emergency departments (ED) before intensive care unit (ICU) admission. This study aims to evaluate the association between time ventilated in the ED and in-hospital mortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS). METHODS This was a multi-center, prospective, observational study of patients ventilated in the ED, conducted at three academic Level I Trauma Centers from July 2011 to March 2013. All consecutive adult patients on invasive mechanical ventilation were eligible for enrollment. We performed a Cox regression to assess for a mortality effect for mechanically ventilated patients with each hour of increasing LOS in the ED and multivariable regression analyses to assess for independently significant contributors to in-hospital mortality. Our primary outcome was in-hospital mortality, with secondary outcomes of ventilator days, ICU LOS and hospital LOS. We further commented on use of lung protective ventilation and frequency of ventilator changes made in this cohort. RESULTS We enrolled 535 patients, of whom 525 met all inclusion criteria. Altered mental status without respiratory pathology was the most common reason for intubation, followed by trauma and respiratory failure. Using iterated Cox regression, a mortality effect occurred at ED time of mechanical ventilation > 7 hours, and the longer ED stay was also associated with a longer total duration of intubation. However, adjusted multivariable regression analysis demonstrated only older age and admission to the neurosciences ICU as independently associated with increased mortality. Of interest, only 23.8% of patients ventilated in the ED for over seven hours had changes made to their ventilator. CONCLUSION In a prospective observational study of patients mechanically ventilated in the ED, there was a significant mortality benefit to expedited transfer of patients into an appropriate ICU setting.
Collapse
Affiliation(s)
- Lauren B Angotti
- Medical University of South Carolina, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Charleston, South Carolina
| | - Jeremy B Richards
- Medical University of South Carolina, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Charleston, South Carolina
| | - Daniel F Fisher
- Massachusetts General Hospital, Respiratory Care Services, Boston, Massachusetts
| | - Jeffrey D Sankoff
- University of Colorado at Denver, School of Medicine, Department of Emergency Medicine, Denver, Colorado
| | - Todd A Seigel
- Kaiser Permanente East Bay, Oakland and Richmond Medical Centers, Department of Emergency Medicine and Critical Care, Oakland, California
| | - Haitham S Al Ashry
- Medical University of South Carolina, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Charleston, South Carolina
| | - Susan R Wilcox
- Medical University of South Carolina, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Charleston, South Carolina.,Medical University of South Carolina, Division of Emergency Medicine, Charleston, South Carolina
| |
Collapse
|
19
|
Joyce MF, Berg S, Bittner EA. Practical strategies for increasing efficiency and effectiveness in critical care education. World J Crit Care Med 2017; 6:1-12. [PMID: 28224102 PMCID: PMC5295164 DOI: 10.5492/wjccm.v6.i1.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/30/2016] [Accepted: 12/13/2016] [Indexed: 02/06/2023] Open
Abstract
Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.
Collapse
|
20
|
Lino JA, Gomes GC, Sousa NDSVC, Carvalho AK, Diniz MEB, Viana Junior AB, Holanda MA. A Critical Review of Mechanical Ventilation Virtual Simulators: Is It Time to Use Them? JMIR MEDICAL EDUCATION 2016; 2:e8. [PMID: 27731850 PMCID: PMC5041346 DOI: 10.2196/mededu.5350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/05/2016] [Accepted: 05/19/2016] [Indexed: 06/01/2023]
Abstract
BACKGROUND Teaching mechanical ventilation at the bedside with real patients is difficult with many logistic limitations. Mechanical ventilators virtual simulators (MVVS) may have the potential to facilitate mechanical ventilation (MV) training by allowing Web-based virtual simulation. OBJECTIVE We aimed to identify and describe the current available MVVS, to compare the usability of their interfaces as a teaching tool and to review the literature on validation studies. METHODS We performed a comparative evaluation of the MVVS, based on a literature/Web review followed by usability tests according to heuristic principles evaluation of their interfaces as performed by professional experts on MV. RESULTS Eight MVVS were identified. They showed marked heterogeneity, mainly regarding virtual patient's anthropomorphic parameters, pulmonary gas exchange, respiratory mechanics and muscle effort configurations, ventilator terminology, basic ventilatory modes, settings alarms, monitoring parameters, and design. The Hamilton G5 and the Xlung covered a broader number of parameters, tools, and have easier Web-based access. Except for the Xlung, none of the simulators displayed monitoring of arterial blood gases and alternatives to load and save the simulation. The Xlung obtained the greater scores on heuristic principles assessments and the greater score of easiness of use, being the preferred MVVS for teaching purposes. No strong scientific evidence on the use and validation of the current MVVS was found. CONCLUSIONS There are only a few MVVS currently available. Among them, the Xlung showed a better usability interface. Validation tests and development of new or improvement of the current MVVS are needed.
Collapse
Affiliation(s)
- Juliana Arcanjo Lino
- Federal University of Ceara, Medicine, Federal University of Ceara, Fortaleza, Brazil.
| | | | | | | | | | | | | |
Collapse
|
21
|
Wilcox SR, Strout TD, Schneider JI, Mitchell PM, Smith J, Lutfy-Clayton L, Marcolini EG, Aydin A, Seigel TA, Richards JB. Academic Emergency Medicine Physicians' Knowledge of Mechanical Ventilation. West J Emerg Med 2016; 17:271-9. [PMID: 27330658 PMCID: PMC4899057 DOI: 10.5811/westjem.2016.2.29517] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/19/2016] [Accepted: 02/05/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) education or clinical practice. The objective of this study was to quantify EM attendings’ education, experience, and knowledge regarding mechanical ventilation in the emergency department. Methods We developed a survey of academic EM attendings’ educational experiences with ventilators and a knowledge assessment tool with nine clinical questions. EM attendings at key teaching hospitals for seven EM residency training programs in the northeastern United States were invited to participate in this survey study. We performed correlation and regression analyses to evaluate the relationship between attendings’ scores on the assessment instrument and their training, education, and comfort with ventilation. Results Of 394 EM attendings surveyed, 211 responded (53.6%). Of respondents, 74.5% reported receiving three or fewer hours of ventilation-related education from EM sources over the past year and 98 (46%) reported receiving between 0–1 hour of education. The overall correct response rate for the assessment tool was 73.4%, with a standard deviation of 19.9. The factors associated with a higher score were completion of an EM residency, prior emphasis on mechanical ventilation during one’s own residency, working in a setting where an emergency physician bears primary responsibility for ventilator management, and level of comfort with managing ventilated patients. Physicians’ comfort was associated with the frequency of ventilator changes and EM management of ventilation, as well as hours of education. Conclusion EM attendings report caring for mechanically ventilated patients frequently, but most receive fewer than three educational hours a year on mechanical ventilation, and nearly half receive 0–1 hour. Physicians’ performance on an assessment tool for mechanical ventilation is most strongly correlated with their self-reported comfort with mechanical ventilation.
Collapse
Affiliation(s)
- Susan R Wilcox
- Medical University of South Carolina, Divisions of Emergency Medicine and Pulmonary, Critical Care and Sleep Medicine, Charleston, South Carolina
| | - Tania D Strout
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine
| | - Jeffrey I Schneider
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Patricia M Mitchell
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Jessica Smith
- Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | | | - Evie G Marcolini
- Yale University School of Medicine, Departments of Emergency Medicine and Neurology, Divisions of Neurocritical Care and Emergency Neurology and Surgical Critical Care, New Haven, Connecticut
| | - Ani Aydin
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Todd A Seigel
- Department of Emergency Medicine and Critical Care, Kaiser Permanente East Bay, Oakland and Richmond Medical Centers, California
| | - Jeremy B Richards
- Medical University of South Carolina, Division of Pulmonary, Critical Care and Sleep Medicine, Charleston, South Carolina
| |
Collapse
|
22
|
Wilcox SR, Richards JB, Fisher DF, Sankoff J, Seigel TA. Initial mechanical ventilator settings and lung protective ventilation in the ED. Am J Emerg Med 2016; 34:1446-51. [PMID: 27139256 DOI: 10.1016/j.ajem.2016.04.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/18/2016] [Accepted: 04/17/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Mechanical ventilation with low tidal volumes has been shown to improve outcomes for patients both with and without acute respiratory distress syndrome. This study aims to characterize mechanically ventilated patients in the emergency department (ED), describe the initial ED ventilator settings, and assess for associations between lung protective ventilation strategies in the ED and outcomes. METHODS This was a multicenter, prospective, observational study of mechanical ventilation at 3 academic EDs. We defined lung protective ventilation as a tidal volume of less than or equal to 8 mL/kg of predicted body weight and compared outcomes for patients ventilated with lung protective vs non-lung protective ventilation, including inhospital mortality, ventilator days, intensive care unit length of stay, and hospital length of stay. RESULTS Data from 433 patients were analyzed. Altered mental status without respiratory pathology was the most common reason for intubation, followed by trauma and respiratory failure. Two hundred sixty-one patients (60.3%) received lung protective ventilation, but most patients were ventilated with a low positive end-expiratory pressure, high fraction of inspired oxygen strategy. Patients were ventilated in the ED for a mean of 5 hours and 7 minutes but had few ventilator adjustments. Outcomes were not significantly different between patients receiving lung protective vs non-lung protective ventilation. CONCLUSIONS Nearly 40% of ED patients were ventilated with non-lung protective ventilation as well as with low positive end-expiratory pressure and high fraction of inspired oxygen. Despite a mean ED ventilation time of more than 5 hours, few patients had adjustments made to their ventilators.
Collapse
Affiliation(s)
- Susan R Wilcox
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Jeremy B Richards
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Daniel F Fisher
- Respiratory Care Services, Massachusetts General Hospital, Boston, MA, USA.
| | - Jeffrey Sankoff
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, CO, USA.
| | - Todd A Seigel
- Department of Emergency Medicine and Critical Care, Kaiser Permanente East Bay, Oakland and Richmond Medical Centers, CA, USA.
| |
Collapse
|
23
|
Richards JB, Strout TD, Seigel TA, Wilcox SR. Psychometric properties of a novel knowledge assessment tool of mechanical ventilation for emergency medicine residents in the northeastern United States. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2016; 13:10. [PMID: 26924540 PMCID: PMC4789563 DOI: 10.3352/jeehp.2016.13.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/14/2016] [Indexed: 05/22/2023]
Abstract
PURPOSE Prior descriptions of the psychometric properties of validated knowledge assessment tools designed to determine Emergency medicine (EM) residents understanding of physiologic and clinical concepts related to mechanical ventilation are lacking. In this setting, we have performed this study to describe the psychometric and performance properties of a novel knowledge assessment tool that measures EM residents' knowledge of topics in mechanical ventilation. METHODS Results from a multicenter, prospective, survey study involving 219 EM residents from 8 academic hospitals in northeastern United States were analyzed to quantify reliability, item difficulty, and item discrimination of each of the 9 questions included in the knowledge assessment tool for 3 weeks, beginning in January 2013. RESULTS The response rate for residents completing the knowledge assessment tool was 68.6% (214 out of 312 EM residents). Reliability was assessed by both Cronbach's alpha coefficient (0.6293) and the Spearman-Brown coefficient (0.6437). Item difficulty ranged from 0.39 to 0.96, with a mean item difficulty of 0.75 for all 9 questions. Uncorrected item discrimination values ranged from 0.111 to 0.556. Corrected item-total correlations were determined by removing the question being assessed from analysis, resulting in a range of item discrimination from 0.139 to 0.498. CONCLUSION Reliability, item difficulty and item discrimination were within satisfactory ranges in this study, demonstrating acceptable psychometric properties of this knowledge assessment tool. This assessment indicates that this knowledge assessment tool is sufficiently rigorous for use in future research studies or for assessment of EM residents for evaluative purposes.
Collapse
Affiliation(s)
- Jeremy B. Richards
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
- *Corresponding
| | - Tania D. Strout
- Tufts University School of Medicine and Department of Emergency Medicine, Maine Medical Center; Portland, ME, USA
| | | | - Susan R. Wilcox
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
- Division of Emergency Medicine, Medical University of South Carolina; Charleston, SC, USA
| |
Collapse
|
24
|
L’enseignement de la réanimation au sein du DESC de médecine d’urgence en France : état des lieux et perspectives. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|