Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents

Abstract

Introduction: Sepsis is a major cause of morbidity and mortality in medicine and is managed in ICUs daily. Critical care training is a vital part of anesthesiology residency, and understanding the presentation, management, and treatment of septic shock is fundamental to intraoperative patient care. Methods: This simulation involved a 58-year-old man undergoing surgical debridement of a peripancreatic cyst with hemodynamic instability and septic shock. We conducted the simulation yearly for clinical anesthesia year 2 residents (n = 26) in 1-hour sessions with three to five learners at a time. The simulation covered the six Anesthesiology Milestones related to sepsis and septic shock as outlined in the Anesthesiology Milestones Project. Results: To date, 155 anesthesiology residents have completed the simulation. Commonly missed critical actions included failure to recognize the need for invasive lines, provide appropriate volumes of fluid resuscitation, inquire about blood cultures and antibiotics, and recognize the need for the patient to remain intubated. Most participants could appropriately diagnose and treat intraoperative septic shock, but all had moments of action or inaction to discuss and improve upon, and all learned from this scenario. Discussion: Simulation is an optimal way to practice the more rare and life-threatening clinical events in medicine. Even though septic shock is commonly managed in the ICU, it is relatively uncommon for it to develop acutely in the OR. This simulation is an effective and educational way to discuss the most recent sepsis/septic shock definition and review evidence-based guidelines for treatment.

Full-Dress Rehearsals with Actual Non-Infected Patients Builds Confidence and Familiarity – An Experience from Singapore during the COVID-19 Pandemic

“…The efficacy of simulation training has been replicated in many areas in medical and surgical practice [7,8]. It also encourages realistic team-based communication training and allows the retention of knowledge and skills for a longer duration [9].…”

Sepsis and Clinical Simulation: What Is New? (and Old)

“…Knowledge of and training in sepsis should not be limited to healthcare professionals [33]. Staff-in-training programs have been shown to be feasible and effective [105] in improving diagnostic skills in multiple clinical settings and across multiple specialties [101,[106][107][108][109][110].…”

“…Beyond recreating complex scenarios in intensive care units, simulation can be applied at all points of care of the septic patient. From diagnosis in long-term care homes [113], admission to the emergency department, passage through intermediate care units [114], the hospital ward [115], or the operating theatre [109], clinical simulation can replicate the situations in which patient care takes place. The development of in situ simulation enables training in complex settings where the early diagnosis and treatment of sepsis is critical, such as emergency departments [16] and rural hospitals and health services [115,116].…”