Prone Positioning for COVID-19-related ARDS: A Task-sharing Intervention (1090-003977) (Research Abstract Professor Rounds: Group 3)
Start time: Thursday, January 28, 2021, 11:30 AM End time: Thursday, January 28, 2021, 12:30 PM Session Type: Research Abstracts (Completed Studies)
In patients with severe acute respiratory distress syndrome (ARDS), prone positioning (proning) has shown to improve alveolar recruitment, gas exchange and decrease 28-day mortality.(1) As many as a third of patients with confirmed Covid-19 infection developed ARDS requiring tracheal intubation.(2) The enormous volume of patients requiring mechanical ventilation in New York City hospitals led to a major gap in performing prone ventilation, a process typically performed by ICU staff.(3) Using the principles of task-sharing, we created an interdisciplinary team of clinical professionals with readily transferable skills to meet the demand for proning COVID-19 patients with ARDS. We seek to evaluate the benefits of simulation training (ST) of an interdisciplinary team with readily transferable skills to meet a large demand for prone ventilation. We hypothesized simulation-based training is an effective modality for safe implementation of prone ventilation performed by an non-ICU team.
We conducted ST for an interdisciplinary prone ventilation team which was organized for the COVID-19 pandemic. Led by our critical care attendings, the prone team included surgeons and physician assistants (PA) from Neurosurgery and Orthopedics with prior experience in proning patients in the operating room, physical and occupational therapists (PT,OT), ICU physicians, nurses and respiratory therapists (RT). Four phases included planning with leadership from each discipline, recruitment, training, and implementation. To simulate realistic obstacles encountered during proning in the ICU setting, monitoring devices, mechanical ventilator, and vascular access devices were attached to a high fidelity mannequin. A previously implemented prone ventilation simulation program for ICU staff members was utilized to train the interdisciplinary team.(4) A post-course questionnaires using a Likert-scale was completed by participants. A Redcaps database was utilized for data collection and analysis.
A total of 9 prone ventilation simulation sessions were conducted and 33 learners completed the training. The 33 learners included learners from Neurosurgery (11), Orthopedics (7), Rehabilitation Medicine (11), Transfusion Medicine (1), Anesthesiology (1) and Endocrinology (1). The learners consisted of 13 physicians, 7 PT, 4 OT, and 8 PAs. The ICU staff had previously undergone ST and had experience in proning. 5 ST for proning normally takes 2-3 hours per session. Given the composition of an ideal “proning team,” the training took <1 hour with 4-6 participants per session. The total time for proning patients was 5 minutes. A post-training survey questionnaire showed 79% strongly agreed and 21% agreed that ST prepared them well for proning. Quantitative and qualitative feedback for the process overall was very favorable, indicating that ST allowed the interdisciplinary team to effectively implement proning skills, leadership and teamwork acquired in ST and into actual proning process.
Facing the unprecedented critical care resource scarcity caused by the COVID-19 pandemic demands collaborative innovation and problem-solving, guided by principles of leadership, effective communication, and interprofessional cooperation. (5) Utilizing effective task-shifting and task-sharing, and integrating simulation training we were able to implement an effective interdisciplinary prone ventilation team to meet the demands of a large pandemic.