Use of Simulation to Improve Best Practice Mechanical Ventilation

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Project Summary Mechanical ventilation is a key life supportive therapy for many of the sickest and most vulnerable patients in the intensive care unit (ICU) but can itself cause patient harm—particularly when best-practices are not used. Short-term risks, including the development of ventilator-associated pneumonia and ventilator-induced lung injury, as well as long-term neuromuscular, psychiatric, and cognitive deficits contribute to the significantly increased mortality of 35% in these patients. Although strong, evidence-based guidelines for the prevention of patient harm exist, studies show that the medical community as a whole does a very poor job adhering to them—to the detriment of our patients. There are several reasons for this poor adherence, but research points to a lack of suitable training and knowledge- and skills-deficits as key culprits. Mechanical ventilation is a complex therapy managed by an interprofessional ICU team, consisting of physicians, nurses, and respiratory therapists, working together as a team, and we believe that interventions aimed at reducing avoidable harm from mechanical ventilation must address this key fact. We propose to develop and test a broad, simulation-based educational curriculum, making use of an advanced patient simulator mannequin that can interact with the ventilator in a realistic manner. We will perform both individual and interprofessional team-based training and assessment to determine the educational impact of our curriculum. Furthermore, we will determine the real-world impact of our curriculum on the delivery of best practice ventilation and patient outcomes at our institution. We believe that we can impact clinical practice with a simulation-based training program, improving patient outcomes.