6533b82bfe1ef96bd128cd1b

RESEARCH PRODUCT

Ventilation workshop - a new concept

subject

description

The use of simulator technology to practise crisis resource management or to train standardised procedures in anaesthesia is a proved concept, although its setup in clinical practice is still in progress. To get a better understanding of the complex pathophysiological and clinical relations in the pulmonary system and the kind of alterations that could be induced by changing the ventilation of an intensive care unit patient, we modified the current concept. We created a workshop, which employs more than just the simulator training in the classical sense. During this workshop the participants attend one patient from admission to an emergency room, until discharge from an intensive care unit (ICU). This is not practicable in real time: therefore the pathophysiological and clinical relations are focused in key scenes. The participants should develop and try their treatment concept together with an instructor in analogy to an ICU round. In lectures and classes we present the specific theory, demonstrate ventilators and we offer the opportunity to self ventilation. To avoid peer pressure, we prefer small groups and we employ no cameras. The course priority is to teach the participants the concept of modern mechanical ventilation rather than checking their capability for crisis resource management (CRM). We use an animal model to illustrate the effects of special ventilation methods which can not be demonstrated with the simulator due to hardware preconditions. This is a swine anaesthetised, ventilated and invasive monitored (pulmonary artery catheter, arterial catheter inserted via the femoral vessels) with an adult respiratory distress syndrome artificially induced by saline lavage. Among the registration of various cardiovascular parameters, the use of a Paratrend monitoring (continuous measurement of arterial blood gases via an arterial line) is necessary. Subsequent we demonstrate the positive or negative effects of different ventilation methods, which could be applicated also to our ”patient” at several stages of his disease. We enhance this impression by employing a natural isolated swine lung, prepared in a special way to preserve the original compliance and resistance especially to demonstrate the high frequency oscillation ventilation. The ventilator workshop is not a typical simulator course with respect to the training of CRMmethods. We rather emphasise a pathophysiological point of interest. The idea to develop such a course concept was born in 1997 at the congress of the German Interdisciplinary Association of Intensivists (DIVI). During a cardiovascular scenario, different ventilation strategies or the use of a pulmonary arterial catheter were necessary. We noticed a big interest even from experienced intensivists in such a course. This concept is applicable to other organ systems. Currently a hemodynamic workshop is in preparation, to contribute to the task of improving medical education with simulator training.