In the treatment of preterm and term born infants, invasive and non-invasive mechanical ventilation is one of the cornerstones. Although respiratory support contributes to the survival and long-term wellbeing of these infants it is also associated with the below complications.
- Pulmonary haemorrhage
- Air leak syndrome
- Chronic lung disease
- Bronchopulmonary dysplasia
Therefore, training in mechanical ventilation for neonatology nurses and doctors is crucial in order to decrease the potential harm of this therapy.
Challenges in mechanical ventilation training
As it may only take a few breaths with too high tidal volume or inspiratory pressure to lead to damage that is irreparable, the vulnerable lung of the premature baby does not allow mistakes in the ventilator settings.
Different simulation programs and lung simulators have been developed to overcome the issue of ‘learning by doing’. These simulators enable users to try different ventilation strategies on typical neonatal scenarios and to even train extreme situations.
Image Credit: neosim AG
One drawback of conventional simulation programs and lung simulators is that the response of the lung to the mechanical ventilation requires the input of the trainer. As it always requires the presence of experienced senior staff, this method does not permit individualized ad hoc training of junior staff, although very useful for team simulations.
Autonomous lung simulators
Low threshold training of junior staff can be performed using a simple to use simulator where the response to a specific treatment is driven by built-in physiological based models not needing any manual input once the simulation is running.
LuSi® (neosim, Switzerland) is one of those lung simulators, not only looking like a sick late preterm baby, but also behaving like one when correctly programmed.
Image Credit: neosim AG
Potential fields of application
The main difference, and biggest benefit compared to conventional simulator programs is the fact that no “driver” is necessary throughout the simulation. This makes autonomous simulators extremely versatile in their application.
They can be used like conventional simulator programs for team simulation training and also for hands-on teaching sessions, from physiological basics to highly sophisticated ventilation strategies.
The physiological feedback enables the real-time assessment of ventilator settings and patient-ventilator interactions. Autonomous simulators can also be utilized for self-training at times of lower workload due to their easy to use interface.
A permanent training space on the neonatology ward which is set up with a ventilator, a simulator and a patient monitor, enables the staff to have individual training sessions whenever someone has time to turn on the ventilator and the simulator.
Programming of scenarios
In every simulation the training is only as good as the programmed scenarios, which is also true for autonomous simulators. The better the physiological models which are utilized with the simulators, the more cumbersome and complicated are the programming of scenarios.
Programming a patient situation with a reasonable evolution that is realistic takes quite some physiological knowledge and, as with other programming, a lot of time. By providing platforms for sharing scenarios, this challenge can at least partially be overcome.
The physiological model, which is utilized to mimic natural behavior of the simulator is quite complex. Whilst programming a new scenario, many different parameters can be modified. Therefore, it is very helpful that these parameters are grouped in main folders.
The majority of the values have a short description in a “mouse-over” menu. So the user will be able to implement even rarely used parameters quickly into their programming without the manual, once familiar with the way programming of scenarios is performed.
Simple scenarios may be programmed offline, but for more sophisticated patient situations it is strongly recommended to program whilst running the simulator with a ventilator.
LuSi can be used for the training of different levels, from simulation of extreme patient conditions with experienced neonatologists, to introducing junior NICU nurses to the principles of mechanical ventilation. Respiratory physiology can be exemplified very easily using two or three different scenarios.
The user can make the requested changes on the spot if any questions arise, plus, in addition to the theoretical input, it can be shown directly on the ventilator/patient monitor.
The biggest difference with this new generation of simulators is that the trainer will have enough time for their students. There is no need to artificially create adequate response of the patient. It is always there already.
Completely new possibilities for mechanical ventilation training in neonatology are offered by autonomous lung simulators. Compatibility with any given ventilator, minimal requirements for programming, and wireless communication will lead to easier application and so help to implement simulation of neonatal respiratory diseases into everyday work in NICUs.
Produced from materials originally authored by Thomas Riedel from University Children's Hospital, Switzerland and The Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland.
About neosim AG
neosim is a Swiss company founded by experts with strong background in lung physiology and mechanical ventilation of intensive care patients. The mission of neosim is to bring high-fidelity physiology and pathophysiology to the patient simulator community.
For training and education of clinicians, especially respiratory therapists and intensive care professionals, neosim simulators create realistic breathing in health and disease. In contrast to other simulators, neosim’s simulators can be treated with intensive care therapy methods and responds like a real human patient. The result manifests itself clinically and can be measured quantitatively with state-of-the-art monitoring in real-time.
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