Assessment of a massive open online course (MOOC) incorporating interactive simulation videos on residents' knowledge retention regarding mechanical ventilation.

BACKGROUND: Understanding respiratory physiology and mechanical ventilation is a challenge for healthcare workers, particularly, medical residents. A team of French-speaking experts developed an innovative MOOC incorporating interactive simulation-based videos and serious games aiming at improving knowledge and skills in mechanical ventilation. Our objective was to evaluate the long-term knowledge retention regarding key concepts presented in this MOOC. METHODS: French residents registered for the MOOC 2020's winter session were invited to participate in a two-step study. The first step consisted in evaluating students' pre-course knowledge of respiratory physiology and mechanical ventilation fusing a 20 five-item multiple choice questions test with a total score ranging from 0 to 100. For the second step, the same students answered the same test (after shuffling the questions) six months after the completion of the course. We assessed the impact of this MOOC on the students' knowledge retention by comparing pre-course and post-course scores. RESULT: Of the 102 residents who agreed to participate in the study, 80 completed the course and their mean ± SD pre-course score was 76.0 ± 8.0. Fifty-one respondents also completed the second and their post-course score was significantly higher than the baseline one (83.1 ± 7.3 vs. 77.5 ± 7.6, p < 0.001). Scores of the first and second rounds did not differ upon comparing respondents' background specialty or number of years of residency. For the vast majority of individual questions (96%), the success rate was higher at the post-course than at the pre-course assessment. CONCLUSION: An innovative MOOC incorporating simulation-based videos was effective in teaching medical residents basic mechanical ventilation knowledge and skills, especially in the field of respiratory physiology and ventilatory modes. We observed effective long-term knowledge retention with a higher score at the post-course assessment six months after the completion of the course compared with the pre-course score.

Nasal High-Flow Nebulization for Lung Drug Delivery: Theoretical, Experimental, and Clinical Application.

The use of nasal high-flow (NHF) therapy is rapidly spreading across acute care facilities. This raises the question of optimal delivery of inhaled medication to patients undergoing this noninvasive ventilatory support consisting in delivering heated and humidified high gas flow rates through nasal cannulas. In this article, we review experimental and clinical work evaluating the delivery of inhaled medication within the NHF circuit to target the lung without interrupting the ventilatory support. Using vibrating mesh nebulizers placed immediately upstream or downstream of the humidification chamber, with flow rates of 30-45 L/min in adults and 2-6 L/min in children and infants, about 1%-10% of the drug charged in the nebulizer may be delivered to the lungs. Compared with conventional facemask aerosol interfaces, this amount is significantly lower than amounts delivered to adults (i.e., up to 25% of the nominal dose), but similar to amounts delivered to children and infants, the latter having a predominantly nasal breathing. However, significant clinical effects have been shown in both populations when delivering bronchodilators through NHF. This interface is particularly well tolerated and may be useful to improve aerosol therapy tolerance in the pediatric setting. Thus, among patients undergoing NHF therapy, bronchodilators may be delivered through this route. Whereas other drugs may be delivered this way or if there is a patient-centered benefit to specifically use NHF for aerosol therapy among patients without ongoing ventilatory support, requires further evaluation and technological development.