Effect of high-frequency chest wall oscillation versus chest physiotherapy on lung function after lung transplant.

PURPOSE: The aim of this study is to compare the effects of chest physiotherapy (CPT) and high-frequency chest wall oscillation (HFCWO) on lung function in lung transplant recipients. BACKGROUND: Chest physiotherapy and HFCWO are routinely used after lung transplant to attenuate dyspnea, increase expiratory flow, and improve secretion clearance. METHODS: In a two-group experimental, crossover design with repeated-measures, 45 lung transplant recipients (27 single, 18 bilateral; 64% male; mean age, 57 years) were randomized to receive CPT at 10:00 AM and 2:00 PM followed by HFCWO at 6:00 PM and 10:00 PM (n=22) or vice versa (n=23) on postoperative day 3. Dyspnea (modified Borg score), Spo2/FiO2, and peak expiratory flow (PEF) were measured pre-treatment and post-treatment. Data were analyzed using chi-square tests, t tests, and linear mixed effects models. RESULTS: There was no statistically significant treatment effect for dyspnea or PEF in patients who received HFCWO versus CPT. However, there was a significant treatment effect on the Spo2/FiO2 ratio (p<0.0001). CONCLUSIONS: Preliminary results suggest that lung function (measured by Spo2/FiO2) improves with HFWCO after lung transplantation. Although dyspnea and PEF did not differ significantly between treatment types, HFCWO may be an effective, feasible alternative to CPT.

Simulation Training in the ICU.

Because of an emphasis on patient safety and recognition of the effectiveness of simulation as an educational modality across multiple medical specialties, use of health-care simulation (HCS) for medical education has become more prevalent. In this article, the effectiveness of simulation for areas important to the practice of critical care is reviewed. We examine the evidence base related to domains of procedural mastery, development of communication skills, and interprofessional team performance, with specific examples from the literature in which simulation has been used successfully in these domains in critical care training. We also review the data assessing the value of simulation in other areas highly relevant to critical care practice, including assessment of performance, integration of HCS in decision science, and critical care quality improvement, with attention to the areas of system support and high-risk, low-volume events in contemporary health-care systems. When possible, we report data evaluating effectiveness of HCS in critical care training based on high-level learning outcomes resulting from the training, rather than lower level outcomes such as learner confidence or posttest score immediately after training. Finally, obstacles to the implementation of HCS, such as cost and logistics, are examined and current and future strategies to evaluate best use of simulation in critical care training are discussed.

Team-Based Learning Improves Staff Nurses' Knowledge of Open- and Closed-Chest Cardiac Surgical Resuscitation.

BACKGROUND: There are few reports of the use of 1-session team-based learning (TBL) in hospital settings and none to teach cardiac surgical resuscitation (CSR). OBJECTIVE: The aim of this study was to investigate whether 1-session TBL is an effective method to increase nursing knowledge of CSR. METHODS: The participating subjects viewed a PowerPoint presentation about CSR prior to the learning session. Participants completed a 16-item individual readiness assessment test. Immediately after, participants in groups of 3 completed the same 16-item test as a team using the Immediate Feedback Assessment Technique form. Participants were asked open-ended questions about their concerns with CSR, which were analyzed with a grounded theory approach. RESULTS: The sample consisted of 60 subjects (54 completing all phases). Team-based learning significantly increased scores from 36.93 (SD, 8.49) to 50.89 (SD, 5.29), t53 = -13.05, P < .001. There was a significant increase in scores (t46 = 2.13, P = .04) among the noncohesive groups from baseline (52.88 [SD, 3.29]) versus the cohesive groups (50.38 [SD, 4.73]). The qualitative data indicated that the subjects had worries/concerns and lack of self-confidence around CSR. DISCUSSION: Team-based learning is a feasible method to use for single-session education where team building is also required. Noncohesive groups may benefit from TBL, from discussing divergent viewpoints to reach a consensus. Additional studies are needed to compare preferences for TBL with other teaching methods.

The effectiveness of and satisfaction with high-fidelity simulation to teach cardiac surgical resuscitation skills to nurses.

BACKGROUND: There are few reports of the effectiveness or satisfaction with simulation to learn cardiac surgical resuscitation skills. OBJECTIVES: To test the effect of simulation on the self-confidence of nurses to perform cardiac surgical resuscitation simulation and nurses' satisfaction with the simulation experience. METHODS: A convenience sample of sixty nurses rated their self-confidence to perform cardiac surgical resuscitation skills before and after two simulations. Simulation performance was assessed. Subjects completed the Satisfaction with Simulation Experience scale and demographics. RESULTS: Self-confidence scores to perform all cardiac surgical skills as measured by paired t-tests were significantly increased after the simulation (d=-0.50 to 1.78). Self-confidence and cardiac surgical work experience were not correlated with time to performance. Total satisfaction scores were high (mean 80.2, SD 1.06) indicating satisfaction with the simulation. There was no correlation of the satisfaction scores with cardiac surgical work experience (τ=-0.05, ns). CONCLUSION: Self-confidence scores to perform cardiac surgical resuscitation procedures were higher after the simulation. Nurses were highly satisfied with the simulation experience.

CNE article: pain after lung transplant: high-frequency chest wall oscillation vs chest physiotherapy.

Background Chest physiotherapy and high-frequency chest wall oscillation (HFCWO) are routinely used after lung transplant to facilitate removal of secretions. To date, no studies have been done to investigate which therapy is more comfortable and preferred by lung transplant recipients. Patients who have less pain may mobilize secretions, heal, and recover faster. Objectives To compare effects of HFCWO versus chest physiotherapy on pain and preference in lung transplant recipients. Methods In a 2-group experimental, repeated-measures design, 45 lung transplant recipients (27 single lung, 18 bilateral) were randomized to chest physiotherapy (10 AM, 2 PM) followed by HFCWO (6 PM, 10 PM; group 1, n=22) or vice versa (group 2, n=23) on postoperative day 3. A verbal numeric rating scale was used to measure pain before and after treatment. At the end of the treatment sequence, a 4-item patient survey was administered to assess treatment preference, pain, and effectiveness. Data were analyzed with χ(2) and t tests and repeated-measures analysis of variance. Results A significant interaction was found between mean difference in pain scores from before to after treatment and treatment method; pain scores decreased more when HFCWO was done at 10 AM and 6 PM (P =.04). Bilateral transplant recipients showed a significant preference for HFCWO over chest physiotherapy (11 [85%] vs 2 [15%], P=.01). However, single lung recipients showed no significant difference in preference between the 2 treatments (11 [42%] vs 14 [54%]). Conclusions HFCWO seems to provide greater decreases in pain scores than does chest physiotherapy. Bilateral lung transplant recipients preferred HFCWO to chest physiotherapy. HFCWO may be an effective, feasible alternative to chest physiotherapy. (American Journal of Critical Care. 2013;22:115-125).