Impact of physician education and availability of parameters regarding esophageal pressure and transpulmonary pressure on clinical decisions involving ventilator management

Abstract

Purpose: This study investigated the effects of physician education and the availability of P_eso and P_L data on physicians' decisions regarding ventilator management during specific simulated clinical conditions.

Materials and methods: The study was a prospective, before-after study using a case scenario-based questionnaire and a case simulator device comprising an Avea ventilator and an artificial lung and esophagus, which was connected to a Series 1101 Electronic Breathing Simulator. The 99 physicians participating in the study were provided with five simulated cases with on-time ventilator graphics without P_eso and P_L and completed a questionnaire on decisions they would make regarding ventilator management of the cases. Then, after receiving instruction on P_eso and P_L, they were given the same cases along with ventilator graphics that included P_eso and P_L.

Results: After receiving instruction and data on P_eso and P_L, statistically significant numbers of physicians changed their answers regarding ventilator management decisions in all five cases.

Conclusions: Providing education and data for P_eso and P_L had a significant effect on physician decisions regarding ventilator management in simulated cases. The use of case scenario-based education with simulator devices for physicians may hasten worldwide understanding and clinical application of P_eso and P_L.

Keywords: Education; Esophageal pressure; Inspiratory effort; Mechanical ventilation; Missed trigger; PEEP; Simulation; Transpulmonary pressure; Work of breathing.