Keep Breathing: A Simulation for Pediatric Residents on Respiratory Complications of Sedation (1090-001157) (Research Abstract Professor Rounds: Group 2)
Start time: Thursday, January 28, 2021, 10:00 AM End time: Thursday, January 28, 2021, 11:00 AM Session Type: Research Abstracts (Completed Studies)
Pediatric patients often require sedation for procedures or studies. Unfortunately, many pediatric residents have limited experience in sedation, and may be unaware of common risk factors for respiratory complications of sedation or their appropriate management. In order to properly care for pediatric patients upon graduation, residents need more experience with sedation. To bridge this knowledge and experience gap, we developed a pediatric simulation scenario using a high-fidelity mannequin, hypothesizing that through simulation, we can teach pediatric and medicine-pediatric residents: 1) to identify the risk factors of obesity, snoring, and obstructive sleep apnea (OSA) for respiratory complications of sedation, and 2) to identify methods to manage upper airway obstruction and central apnea due to sedation, and 3) increase resident confidence in management of respiratory complications of sedation.
The study design was a pre-post intervention survey-based study design. Thirty 2nd-4th year pediatric and medicine-pediatric residents were randomly divided into groups of 4-6 for the session. They were presented with a 10-15 minutes scenario of a sedated 5-year-old obese child with an upper airway obstruction and then central apnea. A Gaumard Hal 2225 mannequin was used. Sedation credentialed pediatric hospital medicine attendings facilitated the simulation to ensure learners met learning objectives by completing a critical action checklist. The checklist included actions such as recognizing and alleviating obstructive apnea, providing supplemental oxygen, and recognizing and treating central apnea. A debrief followed which included standardized teaching points. Residents completed pre-simulation and post-simulation self-assessments and open-ended knowledge-based surveys. Descriptive statistics were used to compare the survey response pre-simulation to post-simulation.
A total of 19 (63%) pre/post surveys were completed. Residents noted an average increase in their confidence to manage respiratory complications during sedations from 3.1 to 4.1 on a 5-point Likert scale (p<0.001). There was a statistically significant improvement in listing the sedation risk factors of obesity, snoring, or OSA from 11% to 89% (p<0.001). The simulation did not significantly change the already high level of awareness of respiratory depression as a complication of fentanyl or midazolam (89% to 100% (P = 0.5)). All respondents listed at least one appropriate intervention to relieve airway obstruction in a sedated child both before and after the simulation.
We demonstrated significant improvement in resident confidence after participation in a simulation-based sedation educational session. In addition, there was significant improvement in identifying obesity, snoring, or OSA as risk factors for respiratory complications of sedation. We did not significantly increase the already high ability of residents to identify methods to manage upper airway obstruction and central apnea due to sedation.