Description: This simulation is introduced with a patient that has a probable pneumonia following an abdominal surgery and required intubation two days post-op. The participant will initially assess the patient post-op day 3. The participant should assess and correct for inadequate oxygenation in the first step by increasing the PEEP. The simulation advances four hours later and the participant is next required to assess and correct for a severe cycle dysynchrony by increasing the set inspiratory times. The case continues to advance to the following day when the participant is required to assess for and correct inadequate oxygenation by increasing the PEEP. However, after the increase in PEEP, the total inspiratory pressure will violate 30 cmH₂O (indicative of volutrauma). This, in addition to a decreased P/F ratio and CXR changes, indicates probable ARDS. The participant is required to decrease the V_T to 6 mL/kg IBW and increase the RR (according to the ARDSnet protocol). However, in addition to these changes, the participant must also request an increase in sedation to prevent cycle dysynchrony and unintended volutrauma.

Patient Population: Adult

Intended Learners: Critical Care Clinicians, Advanced Mechanical Ventilation Learners

Duration: 15 minutes

Learning Goals: The learner develops the knowledge, skills, and critical thinking skills necessary to identify and resolve cycle dysynchrony in PC-AC. The learner developed skills to identify and correct low oxygenation.

Objectives:

1. Recognize trigger dysynchrony utilizing scalar waveforms.
2. Correct cycle dysynchrony by understanding appropriate ventilator parameters.
3. Assess hypoxemia and recommend ventilator parameter changes to correct oxygenation.
4. Identify acute lung injury and implement a lung protective ventilation strategy.

Description: This simulation is introduced with a patient admitted and intubated for symptoms of probable pneumonia; upon patient-ventilator assessment the patient is found to have hypoxemia. The participant is permitted to increase the FiO2, but there is no commensurate increase in oxygenation due to intrapulmonary shunt. PEEP should be increased to 10 cmH2O to improve oxygenation. The participant is asked to correctly assess cycle dysynchrony in the volume A/C mode. Peak inspiratory flow can be decreased, but does not result in resolution of the dysynchrony; VT should be increased to 600 mL to correct for the dysynchrony. The simulation advances 24 hours. The participant is required to assess for continued hypoxemia. The PEEP should be increased to 12-15 cmH2O to improve oxygenation. The participant is required to recognize the presence of ARDS/ALI at this point, as well. A lung protective strategy should be implemented after the increase in PEEP by decreasing the V_Tto 6mL/kg IBW and increasing the RR to compensate for minute ventilation. Following the decrease in V_T, the participant is required to recognize the recurrence of cycle dysynchrony; increasing sedation to correct the cycle dysynchrony is the appropriate / most viable option at this time.

Patient Population: Adult

Intended Learners: Critical Care Clinicians, Advanced Mechanical Ventilation Learners

Duration: 15 minutes

Learning Goals: The learner develops the knowledge and skills to understand how to diagnose and correct trigger dysynchronies. The learner develops the knowledge and skills to understand how to interpret scalar waveforms.

Objectives:

1. Identify inadequate ventilation.
2. Correct inadequate ventilation.
3. Recognize trigger dysynchrony utilizing scalar waveforms.
4. Correct trigger dysynchrony by understanding appropriate ventilator/trigger parameters.
5. Correct trigger dysynchrony by correcting expiratory dysynchrony (air trapping).

Description: This scenario presents a 34-year-old male with suspected COVID-19 already admitted to the Emergency Department. The participants are expected to assess and recognize a deterioration in the patient’s respiratory condition. They should appropriately increase Oxygen support using non-invasive ventilation to correct the hypoxemia while maintaining appropriate respiratory precautions.

Patient Population: Adult

Intended Learners: Critical Care Clinicians, Intermediate Mechanical Ventilation Learners

Duration: 10 minutes

Learning Goals: The learner develops the knowledge, skills and critical thinking necessary to identify low oxygenation and deterioration of the patient’s respiratory condition.

Objectives:

1. Perform a primary assessment of a patient with severe acute respiratory infection.
2. Change the non-invasive support to maximize the patient’s effort.
3. Express the need for oxygenation to stabilize respirations and hypoxemia.

Description: This scenario presents a 48-year-old male with suspected COVID-19 already admitted to the Intensive Care Unit. The learners are expected to assess the patient’s work of breathing, identify the ventilator dysynchrony and perform respiratory interventions. The learners are expected to communicate with the patient and make appropriate ventilator changes throughout the scenario.

Patient Population: Adult

Intended Learners: Critical Care Clinicians, Intermediate Mechanical Ventilation Learners

Duration: 15 minutes

Learning Goals: The learner develops the knowledge, skills and critical thinking necessary to identify deterioration of the patient’s respiratory condition, high peak inspiratory pressures and ventilator dysynchrony.

Objectives:

1. Perform an initial assessment of the patient with a severe acute respiratory infection.
2. Change ventilator settings to improve ventilation.
3. Recognize ventilator dysynchrony and change ventilator settings.
4. Reassess the patient to evaluate the changes made.

Description: This case is a bench simulation in which the learner will observe and identify the evident and subtle effects on measured ventilator parameters when certain ventilator settings are modified. The focus will be on the Pressure Support mode of ventilation. The ventilator settings that will be changed are the set inspiratory pressure, the termination sensitivity, the set PEEP and spontaneous respiratory rate. The learner will identify the effects of the changes to these ventilator settings on respiratory cycle times, pressures, as well as volumes.

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Patient Population: Adult

Intended Learners: Beginner Mechanical Ventilation Learners

Duration: 15 minutes

Learning Goals: The learners improve their understanding of pressure support ventilation and how changes made to the ventilator settings will affect the monitored ventilator data and the patient.

Objectives:

1. Identify the effects on respiratory cycle times, ventilating pressures and volume when modifying the set inspiratory pressure.

2. Identify the effects on respiratory cycle times, ventilating pressures and volume when modifying the termination sensitivity.

3. Identify the effects on respiratory cycle times, ventilating pressures and volume when modifying the set PEEP.

4. Identify the effects on respiratory cycle times, ventilating pressures and volume when the spontaneous respiratory rate increases.

Description: This case is an advanced scenario that addresses missed triggers while ventilating a patient with COPD in VC-AC using the Medtronic Puritan Bennett™ 980. The user will identify improperly set trigger sensitivity and AutoPEEP. The focus will be to properly set the trigger sensitivity to eliminate missed triggers. The learner will increase the set PEEP to counterbalance the AutoPEEP, which will minimize the missed triggers. The learner will also identify the effects of the changes to these ventilator settings on respiratory cycle times, pressures, as well as volumes, which correlate to a lab worksheet provided with this scenario.

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Patient Population: Adult

Intended Learners: Intermediate to Advanced Mechanical Ventilation Learners

Duration: 15 minutes

Learning Goals: The learner develops the knowledge, skills, and critical thinking necessary to identify deterioration of the patient’s respiratory condition, graphic waveforms, trigger sensitivity and AutoPEEP.

Objectives:

1. Suggest and implement methods of reducing airway resistance to minimize AutoPEEP and missed triggers.
2. Suggest and implement methods of increasing expiratory time to minimize AutoPEEP and missed triggers.
3. Adjust PEEP to counterbalance AutoPEEP and minimize missed triggers.

Description: This case is an advanced scenario that addresses missed triggers while ventilating a patient with COPD in VC-AC using the Vyaire Avea™. The user will identify improperly set trigger sensitivity and AutoPEEP. The focus will be to properly set the trigger sensitivity to eliminate missed triggers. The learner will increase the set PEEP to counterbalance the AutoPEEP, which will minimize the missed triggers. The learner will also identify the effects of the changes to these ventilator settings on respiratory cycle times, pressures, as well as volumes, which correlate to a lab worksheet provided with this scenario.

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Patient Population: Adult

Intended Learners: Advanced mechanical ventilation learners

Duration: 15 minutes

Learner Goals:  The learner develops the knowledge, skills, and critical thinking necessary to identify deterioration of the patient’s respiratory condition, graphic waveforms, trigger sensitivity and AutoPEEP.

Objectives:

1. Suggest and implement methods of reducing airway resistance to minimize AutoPEEP and missed triggers.

2. Suggest and implement methods of increasing expiratory time to minimize AutoPEEP and missed triggers.

3. Adjust PEEP to counterbalance AutoPEEP and minimize missed triggers.

Description: This case is an advanced scenario that addresses missed triggers while ventilating a patient with COPD in VC-AC using the Draeger Evita^® Infinity^® V500. The user will identify improperly set trigger sensitivity and AutoPEEP. The focus will be to properly set the trigger sensitivity to eliminate missed triggers. The learner will increase the set PEEP to counterbalance the AutoPEEP, which will minimize the missed triggers. The learner will also identify the effects of the changes to these ventilator settings on respiratory cycle times, pressures, as well as volumes, which correlate to a lab worksheet provided with this scenario.

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Patient Population: Adult

Intended Learners: Intermediate to advanced mechanical ventilation learners

Duration: 15 minutes

Learner Goals:  The learner develops the knowledge, skills, and critical thinking necessary to identify deterioration of the patient’s respiratory condition, graphic waveforms, trigger sensitivity and AutoPEEP.

Objectives:

1. Suggest and implement methods of reducing airway resistance to minimize AutoPEEP and missed triggers.

2. Suggest and implement methods of increasing expiratory time to minimize AutoPEEP and missed triggers.

3. Adjust PEEP to counterbalance AutoPEEP and minimize missed triggers.

Description: This case is an advanced scenario that addresses missed triggers while ventilating a patient with COPD in VC-AC using the Hamilton G5. The user will identify improperly set trigger sensitivity and AutoPEEP. The focus will be to properly set the trigger sensitivity to eliminate missed triggers. The learner will increase the set PEEP to counterbalance the AutoPEEP, which will minimize the missed triggers. The learner will also identify the effects of the changes to these ventilator settings on respiratory cycle times, pressures, as well as volumes, which correlate to a lab worksheet provided with this scenario.

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Patient Population: Adult

Intended Learners: Intermediate to advanced mechanical ventilation learners

Duration: 15 minutes

Learner Goals:  The learner develops the knowledge, skills, and critical thinking necessary to identify deterioration of the patient’s respiratory condition, graphic waveforms, trigger sensitivity and AutoPEEP.

Objectives:

1.  Suggest and implement methods of reducing airway resistance to minimize AutoPEEP and missed triggers.

2. Suggest and implement methods of increasing expiratory time to minimize AutoPEEP and missed triggers.

3. Adjust PEEP to counterbalance AutoPEEP and minimize missed triggers.

Description: This case is an advanced scenario that addresses missed triggers while ventilating a patient with COPD in VC-AC using the Getinge Servo-i^® or Servo-u. The user will identify improperly set trigger sensitivity and AutoPEEP. The focus will be to properly set the trigger sensitivity to eliminate missed triggers. The learner will increase the set PEEP to counterbalance the AutoPEEP, which will minimize the missed triggers. The learner will also identify the effects of the changes to these ventilator settings on respiratory cycle times, pressures, as well as volumes, which correlate to a lab worksheet provided with this scenario.

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Patient Population: Adult

Intended Learners: Advanced mechanical ventilation learners

Duration: 15 minutes

Learner Goals: The learner develops the knowledge, skills, and critical thinking necessary to identify deterioration of the patient’s respiratory condition, graphic waveforms, trigger sensitivity and AutoPEEP.

Objectives: 

1. Suggest and implement methods of reducing airway resistance to minimize AutoPEEP and missed triggers.

2. Suggest and implement methods of increasing expiratory time to minimize AutoPEEP and missed triggers.

3. Adjust PEEP to counterbalance AutoPEEP and minimize missed triggers.

Description: This case is an intermediate to advanced simulation in which the learner is expected to identify, troubleshoot, resolve, and fine tune the ventilator settings for an infant patient with bronchiolitis who is dysynchronous with the ventilator. The learner should utilize ventilator graphics and values to identify dysynchronies such as inappropriate trigger, excessive I-time, inadequate pressure support, and inadequate rise/ramp time. The learner should use this information, along with other labs and vital signs, to guide their changes to correct the dysynchronies listed above. Finally, the learner should then demonstrate the ability to titrate settings to appropriate levels once synchrony is achieved.

Patient Population: Infant (4 months)

Intended Learners: Advanced mechanical ventilation learners

Duration: 10 minutes

Learner Goals: To identify, troubleshoot, resolve, and fine tune an infant patient with ventilator dysynchrony.

Objectives:

1. Identify an infant patient experiencing ventilator dysynchrony.

2. Utilize ventilator graphics and values to identify inappropriate trigger sensitivity, I-time, pressure support, and rise/ramp time.

3. Ensure optimal ventilator settings once patient-ventilator synchrony has been achieved.

Description: This case is an advanced simulation in which the learner is expected to determine an appropriate mode of ventilation and initial settings that are lung protective and follow pediatric ARDS guidelines. The learner should utilize ventilator graphics, measurements, and maneuvers (PV tool) to determine the patients lung compliance and optimal PEEP setting as well as the appropriateness of performing a recruitment maneuver. The learner should use this information along with other labs, vitals, and images to establish a ventilator management strategy.

Patient Population: Adolescent (12yrs)

Intended Learners: Advanced mechanical ventilation learners

Duration: 15 minutes

Learner Goals: The learner develops the knowledge, skills, and critical thinking necessary to utilize all tools at there disposal to effectively determine an optimal ventilator management strategy for a Pediatric ARDS patient.

Objectives:

1. Determine appropriate mode of ventilation and initial ventilator settings that are conducive of lung protective strategy and follow pediatric ARDS guidelines.

2. Identify the use of several PEEP selection strategies to optimize PEEP and maximize lung recruitment.

3. Assess lung compliance using ventilator graphics maneuvers and measurements.

4. Establish a ventilator management strategy using ventilator feedback, labs, vitals and other ancillary information.

Description: This case is an advanced simulation in which the learner is expected to determine an appropriate mode of ventilation and initial settings that are lung protective and follow pediatric ARDS guidelines. The learner should utilize ventilator graphics, measurements, and maneuvers to determine the patients lung compliance and optimal PEEP setting as well as the appropriateness of performing a recruitment maneuver. The learner should use this information along with other labs, vitals, and images to establish a ventilator management strategy.

Patient Population: Adolescent (12yrs)

Intended Learners: Advanced mechanical ventilation learners

Duration: 15 minutes

Learner Goals: The learner develops the knowledge, skills, and critical thinking necessary to utilize all tools at there disposal to effectively determine an optimal ventilator management strategy for a Pediatric ARDS patient.

Objectives:

1. Determine appropriate mode of ventilation and initial ventilator settings that are conducive of lung protective strategy and follow pediatric ARDS guidelines.

2. Identify the use of several PEEP selection strategies to optimize PEEP and maximize lung recruitment.

3. Assess lung compliance using ventilator graphics maneuvers and measurements.

4. Establish a ventilator management strategy using ventilator feedback, labs, vitals and other ancillary information.