A Critical Review of Mechanical Ventilation Virtual Simulators: Is It Time to Use Them?

Lino, Juliana Arcanjo; Gomes, Gabriela Carvalho; Sousa, Nathalia Parente de; Carvalho, Andrea K.; Diniz, Marcelo Emanoel Bezerra; Viana, Ana Carolina Cavalcante; Holanda, Marcelo Alcantara

doi:10.2196/mededu.5350

Cited by 17 publications

(21 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…(51) Logistical problems; limited space in ICUs and emergency rooms; limited clinical settings; potential risks to patients, faculty, and students; and diffi culties in performing arterial blood gas analysis and imaging tests and analyzing their results are some of the obstacles found in MV education. (59,60) Therefore, educational programs and training specifi cally addressing MV, based on realistic or virtual online simulation, are considered promising tools, but, to that end, studies and technological development are needed. (59,60)…”

Section: Training Health Professionals In the Diagnosis And Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Patient-ventilator asynchrony

et al. 2018

Self Cite

View full text Add to dashboard Cite

Patient-v entilator asynchrony (PVA) is a mismatch between the patient, regarding time, flow, volume, or pressure demands of the patient respiratory system, and the ventilator, which supplies such demands, during mechanical ventilation (MV). It is a common phenomenon, with incidence rates ranging from 10% to 85%. PVA might be due to factors related to the patient, to the ventilator, or both. The most common PVA types are those related to triggering, such as ineffective effort, auto-triggering, and double triggering; those related to premature or delayed cycling; and those related to insufficient or excessive flow. Each of these types can be detected by visual inspection of volume, flow, and pressure waveforms on the mechanical ventilator display. Specific ventilatory strategies can be used in combination with clinical management, such as controlling patient pain, anxiety, fever, etc. Deep sedation should be avoided whenever possible. PVA has been associated with unwanted outcomes, such as discomfort, dyspnea, worsening of pulmonary gas exchange, increased work of breathing, diaphragmatic injury, sleep impairment, and increased use of sedation or neuromuscular blockade, as well as increases in the duration of MV, weaning time, and mortality. Proportional assist ventilation and neurally adjusted ventilatory assist are modalities of partial ventilatory support that reduce PVA and have shown promise. This article reviews the literature on the types and causes of PVA, as well as the methods used in its evaluation, its potential implications in the recovery process of critically ill patients, and strategies for its resolution.

show abstract

Section: Training Health Professionals In the Diagnosis And Treatmentmentioning

confidence: 99%

“…(59,60) Therefore, educational programs and training specifi cally addressing MV, based on realistic or virtual online simulation, are considered promising tools, but, to that end, studies and technological development are needed. (59,60)…”

Section: Training Health Professionals In the Diagnosis And Treatmentmentioning

confidence: 99%

Patient-ventilator asynchrony

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Virtual simulators for GHS skills difficult to maintain, such as mechanical ventilation, have been developed. These skills will be essential during pandemics or emerging infectious diseases, which often require providers to extend their normal scope of practice into critical care skills [76].…”

Section: Virtual Realitymentioning

confidence: 99%

“…Human factors methodologies can identify errorprone steps, delineate the relationship between errors in self contamination, and suggest remediation strategies. Simulations can assist in probing processes to identify latent system hazards and human factor effects [29,76,103].…”

Section: Virtual Realitymentioning

confidence: 99%

Simulation and Modeling Applications in Global Health Security

French

2020

Advanced Sciences and Technologies for Security Applications

View full text Add to dashboard Cite

Global health security (GHS) is dependent upon having an adequate and prepared health security workforce. There are currently numerous challenges in establishing and maintaining a health security workforce. The frequency and magnitude of disasters have increased significantly over the past 30 years. Current and future GHS threats, both manmade and natural, require a prepared and flexible healthcare provider workforce ready to respond to current or emerging GHS threats [1]. Developing and maintaining GHS -specific skills in the healthcare workforce is a tremendous logistical challenge. Innovative education technologies, including simulation and digital learning, can be leveraged to achieve preparedness for GHS threats [2].Ebola Virus Disease (EVD), Middle East Respiratory Syndrome (MERS) and other emerging infectious diseases (EID) are also concerns for GHS. The world faces increasing challenges related to natural and manmade disasters as the frequency and magnitude of disasters have increased significantly over the past 30 years. Healthcare workers protect the well-being of people around the world by preventing, detecting, and responding to public health threats. Current and future GHS threats, both manmade and natural, require a prepared and flexible healthcare provider workforce ready to respond to current or emerging threats [3].There is a global public health workforce shortage. The WHO tracks healthcare workforce data on 186 countries, and 57 were insufficient in healthcare provider availability and accessibility [4]. The 2013-2016 African EVD epidemic revealed WHO organizational deficiencies in coordinating responses to public health emergencies and a shifting of priorities away from global health security threats [5]. It Providing initial and sustainment training to the diverse GHS healthcare workforce is expensive and inefficient utilizing the traditional classroom model. Greater demands have been placed on disaster medicine educators. There is a need to develop innovative methods to educate healthcare providers in the ever-expanding body of disaster medicine knowledge [22].Many of these challenges can be met with gaming and simulation technologies new generations of GHS responders have embraced. Simulation-based training (SBT) has been demonstrated to provide effective learning and is increasingly being integrated into healthcare provider education [23]. The advantages of SBT may be summarized as follows: (1) safety-simulated lives and health can be jeopardized to any extent required for training without harming any people; (2) economy-simulated material and equipment can be used, misused, and expended;(3) visibility-simulation can provide visibility in two ways; you can make the invisible visible and control the visibility of details allowing the learner to discern the forest from the trees or the trees from the forest as needed; (4) time control -simulator time can be sped up, slowed down, or stopped. It can also be completely reversed, allowing learners to replicate specific problems, events, or opera...

show abstract

“…Coping with this wartime scenario is characterized by a set of measures taken in order to mitigate the risks and reduce the lethality of COVID-19. Such measures include promoting broad access to digital training (courses and virtual simulators) on using MV 9 ; enabling access to telemedicine; supporting the development and manufacture of mechanical ventilators with technology that is more accessible, making them easier to use, and that are not dependent on components and materials that must be acquired from the international market; making efforts to restore old, inoperative ventilators and to adapt portable ventilators or ventilators used in anesthesiology; creating safe hospital environments for the use of noninvasive ventilation and high-flow nasal cannulas in negative-pressure isolation rooms, if possible; and searching for alternatives to noninvasive ventilatory support, reducing the risk of infection of the health care team and the pressure for indicating tracheal intubation as the first treatment option in the event of oxygen therapy failure ( Figure 1 ). 10 Research funding agencies, universities, industry sectors, medical societies, and other entities have united around these measures, quite often in a supportive and altruistic way, and that is commendable.…”

mentioning

confidence: 99%