The Simulation and Advanced Skills Center at Cleveland Clinic is home to a state-of-the-art lung simulator, the Ingmar ASL 5000TM Breathing Simulator. This high-fidelity lung simulator can mimic almost any kind of breathing pattern and is an invaluable teaching tool for critical care fellows of various disciplines and other members of the care teams.
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The simulator consists of two parts – the actual “lungs,” and a mannequin controlled by the simulator,” explains Ibrahim Sammour, MD, Neonatologist with Cleveland Clinic’s Children’s. “During a simulation session, physician trainees can hear the breathing sounds and intervene on the mannequin accordingly, while the operator monitors whether the intervention is successful.”
Mimicking rare diseases and respiratory crises
In addition to mimicking the breathing patterns of patients, the simulator can also be used to mimic different disease processes.
“The dynamic changes in airway resistance and lung compliance in different situations can be dialed in by the operator, so the simulator opens up many possibilities from an educational perspective,” says Dr. Sammour, emphasizing that this is especially useful in studies of rare respiratory conditions.
“Over the typical three-year training period our trainees may not encounter a particular disease condition in the intensive care setting, simply due to the fact that certain respiratory conditions presenting in respiratory failure, such as cystic fibrosis, is a rare occurrence,” he says. “The simulator allows us to set up rare scenarios, or high-risk situations that require a quick intervention, in a safe and controlled setting. This approach helps ensure a baseline competency of physicians coming out of training.”
Another advantage of the simulator is that it can be used to test how different ventilators and ventilator modes interact with specific patient populations.
“In neonatology I have personally used it as a research tool to investigate how different fine adjustments on the ventilator affect what is known as regional ventilation in a simulated infant with lung disease of prematurity,” says Dr. Sammour. “The results of this work have been presented at a ‘rapid’ poster session at the American Thoracic Society meeting held in San Diego in May 2018.”
He is optimistic that the lung simulator will continue to find new applications in the training of young neonatologists and pediatric intensivists.
“When families trust us with the care of their children, they are trusting us with the most precious thing they have. We need to ensure that that trust continues to be well-placed,” he says. “By having a dedicated simulation program for fellows, residents, nurse practitioners and respiratory therapists, we’re building a team capable of taking care of the most vulnerable group of patients — infants and babies.”
Online curriculum on mechanical ventilation
Evidence-based medicine is a cornerstone of modern medicine and clinical care. To ensure that physician trainees and caregivers have a better understanding of mechanical ventilation, Dr. Sammour and his colleague, Robert L. Chatburn, MHHS, RRT-NPS, FAARC, revitalized an online curriculum, which was previously used to teach adult intensive care fellows the basics of mechanical ventilation, and expanded it to cover pediatric and neonatal patients. Chatburn is Program Manager of Respiratory Care Research at Cleveland Clinic.
“The purpose of the curriculum is to provide a foundation in mechanical ventilation and gas physics to the trainees, help them understand how the ventilator works irrespective of the varying terminology used by different manufacturers, and prepare them for real-life situations,” Chatburn says. “Once we move into a simulated session, we want the trainees to be able to understand what is happening with a particular ventilator, what the waveforms displayed mean, and how gas physics impact the ventilation of their patient.”
Dr. Sammour plans to couple the online curriculum with hands-on low-fidelity exercises for the neonatal-perinatal medicine fellows and, in time, transition over to using the high-fidelity simulator for simulated clinical scenarios. The online curriculum is currently available to practitioners who use mechanical ventilators within the institute and Dr. Sammour and Chatburn are hoping to expand its availability to learners outside of Cleveland Clinic.
Dr. Sammour’s educational incentives transcend his work with fellows and trainees at Cleveland Clinic. At the upcoming 3rd State of the Art Reviews in Neonatal-Perinatal Medicine (Oct. 18-20), he and his colleagues will use the lung simulator to demonstrate to conference attendees the practical utility of the Ingmar ASL 5000 in an academic teaching setting. They will address the different issues clinicians might face while using newer ventilation modes and troubleshoot potential scenarios.
“Knowing that physicians leaving my training program are well-equipped to handle different medical situations, be safe physicians and sources of confidence for the families, is very important to me, and is in line with Cleveland Clinic’s mission of Providing better care of the sick, investigation into their problems, and further education of those who serve,” Dr. Sammour concludes.