Impact of a Mechanical Ventilation Curriculum on Respiratory Therapist Recognition of Patient-Ventilator Asynchrony

Background: Respiratory therapists (RTs) play a crucial role in managing mechanically ventilated patients, such as addressing patient-ventilator asynchronies that may contribute to patient harm. Waveform analysis is integral to the evaluation of patient-ventilator asynchronies; despite this, no published studies have assessed the ability of practicing RTs to interpret ventilator waveform abnormalities.

Methods: The study took place between June 2017-February 2019. Eighty-six RTs from 2 academic medical centers enrolled in a one-day mechanical ventilation course. The scores of 79 first-time attendees were included in the analysis. Prior to and following the course, RTs were asked to identify abnormalities on a 5-question, multiple-choice ventilator waveform exam. They were also asked to provide a self-assessment of their ventilator management skills on a 1 (complete novice) to 5 (expert) scale.

Results: Initial scores were low but improved after one day of ventilator instruction (19.4 ± 17.1 vs 29.6 ± 19.0, P < .001). No significant difference was noted in mean confidence levels between the pre- and post-course assessments (3.8 ± 0.9 vs 3.8 ± 1.0, P = .56). RTs with fewer years of clinical experience (0-10 y) had a statistically significant improvement in their post-course test scores relative to their pre-course scores (0-5 y: 12.5 ± 10.1 to 46.0 ± 10.8, P < .001; 6-10 y: 18.7 ± 15.8 to 32.1 ± 16.7, P = .02), whereas those with > 11 y of clinical experience did not (11-20 y: 22.4 ± 15.5 to 27.4 ± 19.0, P = .44; 21+ y: 19.6 ± 22.1 to 15.3 ± 13.8, P = .50).

Conclusions: RTs may benefit from additional training in ventilator waveform interpretation, especially early in their clinical training. More work is needed to determine the optimal length and content of a mechanical ventilation curriculum for RTs.