Author: Susan Petersen
Heated High Flow Nasal Cannula – Elevated Mean Airway Pressure?
Can the use of Heated High Flow Nasal Cannula (HHFNC) at a high percentage of nare occlusion result in dangerously elevated mean airway pressure (MAP)?
Gerald Moody studied this using the ASL 5000 Breathing Simulator and found that occlusion of nares by nasal cannula greatly influences MAP and significant pressures can be generated when occlusion is greater than 75%. Learn more.
Super User Award Winners
We are delighted to announce the winners of our latest Super User Contest. Our vision at IngMar Medical is to foster collaboration within the respiratory care community to bring about time savings for instructors and researchers, more consistent training, and ultimately better care for patients on mechanical ventilation.
Gerald Moody, RRT
Respiratory Care Practitioner
Children’s Medical Center of Dallas
Product: ASL 5000 Breathing Simulator
Topic: Mean Airway Pressure Generated by HHFNC at Varying Flows and Nare Occlusions
Teresa Volsko, MHHS, RRT, FAARC
Director, Respiratory Care, Transport and the Communications Center
Akron Children’s Hospital
Product: ASL 5000 Breathing Simulator
Topic: Simulation: from Bench to Clinical Practice (available soon)
Ventilator Alarm Safety
Alarm hazards are number one on the list of Top 10 Health Technology Hazards published by the Emergency Care Research Institute (ECRI). Ventilator disconnections not caught because of mis-set or missed alarms ranks as number five.
“It is still too easy to set alarm limits and parameters incorrectly,” stated Brad Bonnette, health devices product engineer, ECRI at the 2014 AAMI/FDA Summit on Ventilator Technology.
Helping clinicians become competent in setting initial alarms is a special emphasis of IngMar Medical’s “Initiation of Mechanical Ventilation” Curriculum Module to be released later this summer. Working with the RespiPatient® manikin, learners get hands-on practice setting initial alarms, then adjusting alarms when the patient’s condition changes.
The challenge of learning to set alarms correctly is complicated by the lack of clinical practice guidelines for ventilator alarm settings. Guidelines differ from hospital to hospital and there are even differences between major mechanical ventilation textbooks. This can mean that clinicians need to be trained for each clinical setting.
The settings provided in the simulations are a result of a rigorous review of published values in respected mechanical ventilation textbooks as well as common clinical practice. An overview table of the recommended ventilator settings from the textbooks is provided with the modules and educators can tweak the simulation to teach the values they prefer.
RTs – Take Charge!
Interview with Amanda Dexter, module co-author (with Eric Kriner)
Q: IngMar Medical will be releasing its new Initiation of Mechanical Ventilation Modules for the RespiSim® System shortly. Why is this topic important?
A: This is a high-stakes emergency situation where the Respiratory Therapist (RT) plays a central role. Everyone is relying on the RT to be the expert and take charge. Unfortunately, there are no nationally accepted guidelines for initiating mechanical ventilation or for setting alarms. Guidelines vary from school to school and from hospital to hospital, therefore students need to have a deep understanding of lung mechanics.
Q: What are some common problems that occur when initiating mechanical ventilation?
A: People tend to use the modes they feel most comfortable with – this is understandable in a high-risk situation. However, sometimes the modes used are not appropriate for the particular patient. RT’s can also be timid about using spontaneous modes at initiation. Setting the correct alarms can be a challenge. Students can forget that a patient may require mechanical ventilation for reasons other than a problem with the lungs. For example, patients with a drug overdose often cannot breathe on their own as a result of a neurological issue, not a lung issue.
Q: What can be the impact of those errors?
A: Using an inappropriate mode can result in a longer time on the ventilator. If alarms are not set correctly, alarm fatigue can occur. This is a serious patient safety concern.
Q: How can simulation training help?
A: Simulation training allows students and clinicians to become comfortable with a wide range of ventilator modes. Learners can experiment, take risks, and practice individual skills and teamwork without harming patients. You can also fast-forward to a point when the patient’s condition or their effort has changed.
Q: Can you walk me though how the new “Initiation of Mechanical Ventilation” modules work?
A: Learners get to experience the whole process, starting with intubating the RespiPatient manikin. The learners then must set up the initial ventilation and alarms according to the flowchart. Then we fast-forward four hours and the ventilator is alarming because the patient’s condition has changed. The student must adjust the ventilator and alarm settings, making sure to record ventilator and alarm settings on their flow sheets. See example.
There are ten different modules so learners can become familiar with a wide range of cases.
Q: Will these modules help students pass the NBRC Simulation exam?
A: Initiating mechanical ventilation is big topic in the NBRC SIM exam. Practicing the analytic and hands-on skills should help to deepen and anchor knowledge. We are also working on a set of modules specifically designed to help prepare for the NBRC SIM exam.
Respi-Dog? Veterinary Simulation Training with the ASL 5000
The Cornell College of Veterinary Medicine is using the ASL 5000 Breathing Simulator in combination with a canine manikin to provide immersive simulation for clinical training. Who would have thunk it? But of course it makes perfect sense – we don’t want novice clinicians practicing on our loved ones, whether human or canine.
Simulation provides a safe environment for hands-on practice and exploration – with no risk to patients. The ASL 5000’s ability to simulate human patients from neonatal to adult makes it appropriate for simulating all sizes of animal patients.
The Cornell system is actually known as Rescue Dog and is the creation of Daniel Fletcher, Associate Professor Emergency and Critical Care.
Bicycle Friendly Business Award
IngMar Medical is now a League of American Bicyclists recognized Bronze Level Bicycle Friendly Business (BFBSM)! 
IngMar Medical joins a forward-thinking group of more than 950 local businesses, government agencies and Fortune 500 companies across the United States that are transforming the American workplace. Other awardees in Pittsburgh include Highmark, 4Moms, 11 Stanwix, Group Against Smog and Pollution, and Tree Pittsburgh.
“BikePgh certified our company as a Bike Friendly Employer several years ago and encouraged us to apply for this award,” said Stefan Frembgen, President of IngMar Medical. “We are proud to be a corporate member. BikePgh is transforming our streets and making them safer for everyone.”
“Visionary business leaders are recognizing the real-time and long term impact that a culture of bicycling can create,” said Andy Clarke, President of the League of American Bicyclists. “We applaud this new round of businesses for investing in a more sustainable future for the country and a healthier future for their employees.”
Learn more about the League’s Bicycle Friendly Business program at bikeleague.org/business.
Finding Time for Hands-on Training
One of the challenges posed by shifting to more hands-on learning is finding time in the curriculum. Eric Kriner at MedStar Washington Hospital Center explains how he uses self-paced learning in place of the traditional lecture format. Read the full story.
Studying Neonatal CPAP Delivery
How effective is the delivery of neonatal nasal CPAP through a variety of devices? The answer to this question could have a critical impact on the long-term health of a neonate.
Allan Prost at the Southern Alberta Institute of Technology has set out to investigate the effectiveness of the SiPAP, regular oxygen nasal prongs, and specialty prongs like the RAM using the ASL 5000 Adult/Neonatal Breathing Simulator. Read the full story.
Anesthesia Miracle: No Power, No Oxygen
Frustrated with anesthesia machines that conked out when the power faltered, Dr. Paul Fenton came up with a solution: The Universal Anesthesia Machine.
Fenton’s Universal Anesthesia Machine took home the top health prize at the Tech Awards Gala. The awards salute innovations that address urgent humanitarian problems. Read the full story on NPR.
Johns Hopkins Department of Anesthesiology and Critical Care Medicine (ACCM) is helping to introduce Gradian’s Universal Anesthesia Machine in Sierra Leone. For their training they used IngMar Medical’s RespiTrainer® —a multi-skill ventilation and airway trainer—and its QuickLung® Breather—a test lung capable of active breathing. Read the full story.
Super User Award Winners
We are delighted to announce the winners of our first AARC Congress Super User Contest. Our vision at IngMar Medical is to foster collaboration within the respiratory care community to bring about time savings for instructors and researchers, more consistent training, and ultimately better care for patients on mechanical ventilation.
We will be posting their user stories in the weeks leading up to the AARC Congress. Stay tuned!
Tammy Babcock
Assistant Professor/Director of Clinical Education
UTMB School of Health Professions: Respiratory Care
Product: ASL 5000 Breathing Simulator
Topic: How to Integrate the ASL 5000 Breathing Simulator with the Laerdal SimNewB
Suzan Herzig
Clinical Coordinator
UC San Diego Health System
Product: QuickLung Precision Test Lung
Topic: Uncovering a Nebulizer Setup Error using the QuickLung®
Gerald Moody
Respiratory Care Practitioner
Children’s Medical Center of Dallas
Product: ASL 5000 Breathing Simulator
Topic: Differences in Ventilator Performance Characteristics and Patient Response
Allan Prost
Instructor, Respiratory Therapy
Southern Alberta Institute of Technology, Canada
Product: ASL 5000 Breathing Simulator
Topic: Studying the Delivery of Neonatal CPAP through Various Devices
Maximilian Tang
Undergraduate Researcher
Harvard-MIT Health Sciences and Technology – Poon Lab
Product: ASL 5000 Breathing Simulator
Topic: Ventilator Development.