Ventilator waveform interpretation skills of attending intensivists relative to critical care fellows (VISA) study.

Abstract

Background: Mechanical ventilation can be lifesaving for critically ill patients. However, there is evidence that intensivists' mechanical ventilation management skills are lacking, presenting a potential risk to patient safety. Ventilator waveform interpretation skills of intensivists need to be further studied to address learning gaps among intensivists.

Objectives: We aimed to study the baseline ventilator waveform interpretation and management skills of attending intensivists compared to those of critical care fellows in academic medical institutions in the United States.

Methods: This prospective multi-institutional investigation spanned 7 US cities where the Multi-Institutional Fundamentals of Mechanical Ventilation Course (MFMVC) took place in July and August 2023. Participants included attending intensivists (study group) from academic medical centers and critical care fellows (control group) who participated in the MFMVC. A validated ventilator waveform test was administered pre- and post-MFMVC. The primary outcome was the pretest scores of intensivists compared to fellows.

Results: Thirty-three attendings and 136 fellows took the pretest and 29 attendings and 135 fellows took the posttest. Mean ± SD pretest scores out of 100 points were 24.3 ± 22.3 for attendings and 16.9 ± 18.7 for fellows (P = .0503). Posttest scores for attendings (45.6 ± 25.5; delta score, 21.3; P = .0015) and fellows (43.6 ± 24.0; delta score, 26.7; P <.00001) significantly improved. There was no difference in posttest scores between attendings versus fellows (P = .69).

Conclusions: Intensivists' ventilator waveform interpretation and management skills are not different from those of critical care fellows before and after a mechanical ventilation course. These findings highlight a need for targeted educational interventions given the apparent concerning knowledge gaps among intensivists post-fellowship.