Demonstration and instructions on how to use OP’s Ventilator Simulator
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by Craig Smallwood, RRT
This video provides an introduction to, and instructions for, the OPENPediatrics virtual ventilator simulator, which can be accessed at no cost on our clinician community site.
The virtual ventilator is an immersive online mechanical ventilation training tool. This tool allows the user to take care of virtual patients without having to actually be in the intensive care unit; training can happen on any computer with an internet connection.
The virtual ventilator incorporates realtime changes in vital signs, ventilatory parameters, patient appearance, arterial blood gases, chest X-rays and more. Users are required to interpret physiologic, imaging and ventilator data, formulate diagnoses and make changes to best treat their patients.
Welcome to the Virtual Ventilator. I’d like to get you started using the ventilator and treating your virtual patients as soon as possible, but before you do, I’m going to give you a brief introduction to the application, including navigating to it from the home page, a general overview of the three sections that you’ll see inside the application, and lastly, but most importantly, you’ll get a quick demo of the functions, as well as a few hints to help you along the way. From openpediatrics.org, click Login in the right hand corner of the page, enter your username and password, click the Library icon in the left hand navigation bar, filter by simulation, and select the Ventilator Simulator.
You can see here that the developer simulator is broken into three distinct sections. First, the knowledge guide. Imagine a textbook on mechanical ventilation that allows you to not only read important information, but see concepts come to life with real time breath sounds, ventilator waveforms, capnograms, blood gases, chest x-rays, and more. You’ll be able to make changes to the ventilator and get familiar with the interface. This is a great review of fundamental mechanical ventilation concepts and a great place to start for someone with less experience or someone who would appreciate a review.
Next, the tactic section. It’s a way to test some of the skills you learned in the knowledge guide. You’ll be put into a scenario in which your patient has usually a single issue. You’ll need to identify the problem, and then figure out the best and most appropriate solution, and implement that solution. Although you’ll need to pass each tactic in order to proceed, you’ll receive some feedback and hits along the way to help you learn from your stakes so you can nail it on your next try.
And lastly, the cases. This is an immersive bedside experience. The cases simulate an entire admission. Although your patient will be in the hospital for a simulated two to five day period, don’t worry. It should only take you about 30 minutes to complete a single case. You’ll be asked to set up the ventilator, diagnose your patient, and make the most appropriate changes based on your patient’s condition. As you progress through the case, you’ll periodically get scored on how you’re doing. If you score high enough, you can even earn a medal at the completion of the case.
Now that you’re familiar with how the Virtual Ventilator is laid out, let’s take a look at a single tactic and learn how to use it. Let’s quickly take a look at some of the functions that you’ll see when you interact with the Ventilator Simulator. Here you’ll see the ventilator waveforms, pressure, flow, volume, the monitor parameters here, all the set parameters here, and the mode that is currently implemented in the top left corner. Clicking on the patient icon pulls up a snapshot of your patient where you can listen to breath sounds, check endotracheal tube position, and also investigate the circuit connections.
This is the monitor parameter, which gives you the vital signs, including Sp02, heart rate, blood pressure, and respiratory rate, as well some pertinent waveforms. If we click on the end tidal CO2 icon, we’ll pull up the capnogram. This little Droplet icon represents the arterial blood gas. You can perform a new one by clicking this icon and waiting for the results. The X-ray icon pulls up the most recent x-ray if available, and you can also request a new one. The next two buttons are interventions that you’ll be able to perform if you deem them necessary. You’ll see the physical interventions here, such as suctioning, recruitment maneuvers, or even excavating your patient. And then pharmacological interventions, including bronchodilators, and sedation and fluid boluses.
Let’s make a couple changes. We’re going to increase the respiratory rate by touching the Respiratory Rate icon, turning the knob, and clicking Accept. We can also turn down our FiO2 in the same fashion. If you need to pull up your alarm information, that is here. If you need to pull up more information, including your patient select size, or if you want to change the mode, you’ll see that here. If you need to pull up the patient’s chart and review it, you can find it here, and if at any time you need to return to the Venitlator Simulator home page, you can click the Back button.
For the tactics, you’ll see on the right hand portion of the screen a drop down menu, which includes all possible options for what problem you’re trying to treat with this patient. Selecting the appropriate one allows you to continue and try to alleviate that problem. On this screen, you’ll see a paragraph kind of describing the tactic that you just completed, as well some specific feedback on how you performed. The performance is generally shown here with either a green check mark, a yellow icon, which indicates some improvement you could have made, but generally acceptable, or red, which is unacceptable. Pay close attention to this stuff because you may want to review some of that material before proceeding to the next tactic or case.
Now that you’ve seen how to use the Ventilator Simulator, I want to give you a few tips and tricks to help you along the way. When you’re treating patients inside the simulator, treat it as much like you would a real patient as possible. Don’t forget to set up your ventilator correctly, including the pre-use test, and input the correct weight so that you can interpret the tidal volumes most appropriately. Be sure to check in on your patient often. Look for changes in breath sounds, physical appearance, or anything in the respiratory exam, including ventilator waveforms or monitor parameters. If your patient condition changes, it may require intervention on the ventilator.
And do not forget the alarms, especially after you’ve made changes. Your simulated patient is set up such that their breath sounds, their physical appearance, their vital signs, x-rays, blood gases, and ventilator waveforms will all reflect their condition. Remember to monitor them all very closely. Remember to treat this as much like a real patient as possible. Good luck and have fun.