Implementing Automated Prone Ventilation for Acute Respiratory Distress Syndrome via Simulation-Based Training

Abstract

Background Prone position ventilation (PPV) is recommended for patients with severe acute respiratory distress syndrome, but it remains underused. Interprofessional simulation-based training for PPV has not been described. Objectives To evaluate the impact of a novel interprofessional simulation-based training program on providers’ perception of and comfort with PPV and the program’s ability to help identify unrecognized safety issues (“latent safety threats”) before implementation. Methods A prospective observational quality improvement study was done in the medical intensive care unit of an academic medical center. Registered nurses, physicians, and respiratory therapists were trained via a didactic session, simulations, and structured debriefings during which latent safety threats were identified. Participants completed anonymous surveys before and after training. Results A total of 73 providers (37 nurses, 18 physicians, 18 respiratory therapists) underwent training and completed surveys. Before training, only 39% of nurses agreed that PPV would be beneficial to patients with severe acute respiratory distress syndrome, compared with 96% of physicians and 70% of respiratory therapists (P < .001). Less than half of both nurses and physicians felt comfortable taking care of prone patients. After training, perceived benefit increased among all providers. Comfort taking care of proned patients and managing cardiac arrest increased significantly among nurses and physicians. Twenty novel latent safety threats were identified. Conclusion Interprofessional simulation-based training may improve providers’ perception of and comfort with PPV and can help identify latent safety threats before implementation.

Rapid Critical Care Training of Nurses in the Surge Response to the Coronavirus Pandemic

“…For example, neither the widespread use of prone positioning to maintain ventilation-perfusion matching in patients with acute respiratory distress syndrome, nor the challenges of maintaining the patency of vascular catheters and dialysis circuits, was anticipated and thus neither was addressed. 4 Coverage of these topics would have been beneficial, but it also would have lengthened the curriculum, thereby limiting the number of courses we would have been able to offer.…”

Prone Positioning and Survival in Mechanically Ventilated Patients With Coronavirus Disease 2019–Related Respiratory Failure*

“…Despite these consensus recommendations, proning remains underused in intubated patients with moderate-to-severe hypoxemia (6, 7). Potential reasons for this underutilization include concerns regarding hemodynamic instability (8), as well as limitations in hospital resources, staff comfort, and education (9, 10). These limitations become more pronounced with the surge of patients seen in the COVID-19 pandemic.…”

Clinical Outcomes of Routine Awake Prone Positioning in COVID-19 Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…The effectiveness of APP remains to be established in RCTs, likely due to multiple implementation barriers such as adoption, feasibility, and tolerability. Although APP is a more cost-effective therapy than IMV and extracorporeal membrane oxygenation (ECMO) for managing ARDS, APP is perceived as a labor-intensive intervention and often deferred due to the desire to minimize staff exposure and use of personal protective equipment (Poor et al, 2020;Weatherald et al, 2021). Our meta-analysis was restricted to eight RCTs, and the huge weightage of the RCT by Ehrmann et al (2021) might have influenced the outcomes of our meta-analysis.…”