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        Effectiveness of online versus in-person structured training program on arterial blood gas, electrolytes, and ventilatory management of critically ill patients

        Gaurav Jain,Bhavna Gupta,Priyanka Gupta,Sagarika Panda,Sameer Sharma,Shalinee Rao 대한중환자의학회 2021 Acute and Critical Care Vol.36 No.1

        Background: Due to the risk of viral transmission during in-person training, a shift towardonline platforms is imperative in the current pandemic. Therefore, we compared the effectivenessof an in-person interactive course with a structurally similar online course designedto improve cognitive skills among clinical health professionals in arterial blood gas analysis,management of electrolyte imbalances, and approaches to mechanical ventilation in criticallyill patients. Methods: In an observational, outcome assessor-blinded, cohort trial, group A included participantsenrolled prospectively in an online course, while group B included those who tookpart in an in-person course (retrospective arm). The primary objective was comparison ofcognitive skills through a pre and post-test questionnaire. Statistical analysis was performedusing Student t-test. Results: In total, 435 participants were analyzed in group A, while 99 participants were evaluatedin group B. The mean pre-test score was 9.48±2.75 and 10.76±2.42, while the meanpost-test score was 11.94±1.90 (passing rate, 64.6%) and 12.53±1.63 (passing rate, 73.3%)in groups A and B, respectively. Group B scored significantly higher in both pre-test (P=0.001)and post-test evaluations (P=0.004). The improvement in post-test score was significantlygreater (P=0.001) in group A (2.46±2.22) compared to group B (1.77±1.76). The medicalspecialties fared better in group B, while surgical specialties scored higher in group A. Thepre-test vs. post-test scores exhibited a moderate correlation in both groups (P<0.001). Thefeedback survey showed a Likert score >3.5 for most points in both groups. Conclusions: The online teaching module exhibited a significant benefit in terms of participantsensitization and knowledge sharing.

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        Use of human patient simulator for apnea studies: a preliminary in vitro trial

        Tripathy Debendra K,Dhar Mridul,Bhardwaj Bharat B,Hemanthkumar K,Talawar Praveen,Rao Shalinee 대한마취통증의학회 2022 Korean Journal of Anesthesiology Vol.75 No.5

        Background: Modern human patient simulators (HPSs) could be used for researching critical scenarios such as apnea oxygenation. We aimed to study the use of a high-fidelity HPS to assess prolonged apnea using various oxygenation strategies with a simple high-flow nasal cannula (15 L/min). Methods: An experimental simulation study using an HPS (CAE Healthcare™) was conducted after obtaining approval from the Institutional Review Board. The HPS responded according to real-time physiologically modeled responses to external gases, such as oxygen (O2). Apnea experiments were performed with different physiological settings, such as shunt fraction (5%) and O2 consumption (250, 500, and 750 ml/min). The following four apnea experiments were conducted: no oxygenation (NO), apnea oxygenation alone (AO), preoxygenation alone (PO), and para-oxygenation (PAO). The time to 92%, 75%, and 50% saturation was recorded. Alveolar and arterial gas levels were recorded till 50% saturation. Results: At 250 ml/min, PO (1121 s) and PAO (1274.5 s) had a significantly longer time to 50% saturation (400% increase) compared to NO (222.5 s) and AO (239 s). A similar trend was observed for the time to 92% and 75% saturation. At higher O2 consumption rates, a shorter time to desaturation was observed. Conclusions: Apnea trends in the HPS correlated with similar prior human experiments. AO without preoxygenation was found to provide no additional benefit. Preoxygenation with high-flow O2 via nasal cannula prolonged the time to desaturation in the PAO more than PO scenario. Therefore, HPSs can be used in future studies where patient safety is a concern.

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