Developing and Implementing Noninvasive Ventilator Training in Haiti during the COVID-19 Pandemic.
Developing and Implementing Noninvasive Ventilator Training in Haiti during the COVID-19 Pandemic.
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在Covid-19大流行期间，在海地开发和实施无创呼气器培训。
DOI：
10.34197/ats-scholar.2021-0070oc
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发表时间：
2022-03
期刊：
影响因子：
1.9
通讯作者：
Fort, Alexander C
中科院分区：
文献类型：
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作者：
Jackson, Peter;Siddharthan, Trishul;Cordoba Torres, Ivet T;Green, Barth A;Policard, Chantal Jean-Pierre;Degraff, Jerry;Padalkar, Roma;Logothetis, Kathryn B;Gold, Jeffrey A;Fort, Alexander C
无创通气（NIV）是一系列心肺疾病呼吸治疗的重要组成部分。世界卫生组织建议使用NIV，以减少重症监护室资源的使用，并在冠状病毒病（COVID-19）患者容量高的时期改善呼吸衰竭患者的预后。然而，包括海地在内的许多低收入和中等收入国家的医疗保健提供者没有NIV的经验。我们在海地太子港进行了NIV培训和评估。在海地设计和实施一个多模式NIV培训计划，以提高NIV用于呼吸衰竭的信心和知识。2021年1月，我们为36名海地医护人员进行了为期3天的多模式NIV培训，包括教学课程、团队学习和多站模拟。该课程包括5个教学会议和10个基于问题的模拟会议。所有课程材料都是由研究小组根据继续医学教育认证理事会批准的内容和对现有证据的审查独立创建的。所有参与者都完成了培训前和培训后基于知识的考试和信心调查，其中使用了5分制李克特量表。共有36名参与者被纳入培训和分析，平均年龄为39.94岁（标准差[SD] = 9.45），参与者平均有14.32年（SD = 1.21）的临床经验。大多数受训人员（75%，n = 27）是医生。其他专业包括护理（19%，n = 7）、护士麻醉（3%，n = 1）和呼吸治疗（3%，n = 1）。50%（n = 18）的参与者表示他们以前有过NIV的经验。大部分学员（77%）的自信调查得分有提高，平均自信调查得分从培训后的2.75（SD = 0.77）提高到3.70（SD = 0.85）（P < 0.05）。培训后知识考核平均分提高39.63%（SD = 15.99%），差异有显著性（P < 0.001）。这种多模式的NIV培训，其中包括教学，模拟和基于团队的学习，是可行的，并导致学员的信心和知识与NIV显着增加。该课程有可能为许多中低收入国家提供NIV培训，因为他们正在管理持续的COVID-19大流行和非传染性疾病日益增加的负担。有必要开展进一步研究，以确保这些改善措施的可持续性和对其他低收入和中等收入环境的适应性。
Noninvasive ventilation (NIV) is an important component of respiratory therapy for a range of cardiopulmonary conditions. The World Health Organization recommends NIV use to decrease the use of intensive care unit resources and improve outcomes among patients with respiratory failure during periods of high patient capacity from coronavirus disease (COVID-19). However, healthcare providers in many low- and middle-income countries, including Haiti, do not have experience with NIV. We conducted NIV training and evaluation in Port-au-Prince, Haiti. To design and implement a multimodal NIV training program in Haiti that would improve confidence and knowledge of NIV use for respiratory failure. In January 2021, we conducted a 3-day multimodal NIV training consisting of didactic sessions, team-based learning, and multistation simulation for 36 Haitian healthcare workers. The course included 5 didactic session and 10 problem-based and simulation sessions. All course material was independently created by the study team on the basis of Accreditation Council for Continuing Medical Education–approved content and review of available evidence. All participants completed pre- and post-training knowledge-based examinations and confidence surveys, which used a 5-point Likert scale. A total of 36 participants were included in the training and analysis, mean age was 39.94 years (standard deviation [SD] = 9.45), and participants had an average of 14.32 years (SD = 1.21) of clinical experience. Most trainees (75%, n = 27) were physicians. Other specialties included nursing (19%, n = 7), nurse anesthesia (3%, n = 1), and respiratory therapy (3%, n = 1). Fifty percent (n = 18) of participants stated they had previous experience with NIV. The majority of trainees (77%) had an increase in confidence survey score; the mean confidence survey score increased significantly after training from 2.75 (SD = 0.77) to 3.70 (SD = 0.85) (P < 0.05). The mean knowledge examination score increased by 39.63% (SD = 15.99%) after training, which was also significant (P < 0.001). This multimodal NIV training, which included didactic, simulation, and team-based learning, was feasible and resulted in significant increases in trainee confidence and knowledge with NIV. This curriculum has the potential to provide NIV training to numerous low- and middle-income countries as they manage the ongoing COVID-19 pandemic and rising burden of noncommunicable disease. Further research is necessary to ensure the sustainability of these improvements and adaptability to other low- and middle-income settings.