著者は、カリキュラムの開発と実行の彼女の援助のためのアンナ Ciullo、MD を感謝したいです。このレポートの外部資金はありませんでした。

ここで説明したすべてのメソッドは、レビューから除外されるよう Summa 制度審査会によって見つけられました。
1 日 1 – 事前テストの評価
<ol><li>重要なアクション チェックリスト、プリテスト景況感調査結果、プリテスト認知多肢選択試験を印刷します。</li>
	<li>以下の名称を ICU ベッド 3 つ人間患者シミュレータを配置: 急性呼吸窮迫症候群 (ARDS)、無気肺粘液を差し込むと気胸にセカンダリ。別々 の部屋でシミュレータを設定またはまで十分離れて、学習者が、同時に他を簡単に聞くことができる場合もなりますがセッションを実行します。専用の学習スペースにシミュレータを配置します。</li>
	<li>人間患者シミュレータを挿管します。シミュレータがシミュレータの首の後ろにつながるシミュレータの内側の頬の穴からではなく気管に気管内チューブを置かないでください。<ol>
<li>今シミュレータの首の後ろに隠されている気管内チューブを肺シミュレータから段ボールの気管チューブを接続します。一度接続すると、肺シミュレータは機能的な今です。この接続を隠すために枕を使用します。</li>
	</ol>
</li>
	<li>肺シミュレータを入れます。患者のライブラリ フォルダーのメニューから選択した病理学的状態を選択します。肺シミュレータの選択した病理を開始します。<ol>
<li>シミュレータの口から出てくる気管内チューブに人工呼吸器を接続します。人工呼吸器は、肺の病理学のソフトウェア プログラムを開始する前に気管内チューブに接続されて、人工呼吸器は正しく機能しません。</li>
		<li>シミュレータを呼吸人間患者シミュレータに接続します。挿管の人間患者シミュレータを機械的人工呼吸器に接続します。</li>
	</ol>
</li>
	<li>各人間患者シミュレータによる模擬患者モニターを配置します。肺シミュレータ プログラム内でバイタル サイン ソフトウェアを選択します。模擬患者のプレゼンテーションの発症のための適切な初期バイタル サインを選択します。バイタル サイン モニターを有効にします。</li>
	<li>事前に選択された患者のバイタル サイン、ポータブル胸部 x 線像、心電図検査は、各症例のため動脈血ガス測定を各それぞれ患者モニター (例えば、autoPEEP 人間患者シミュレータに画像をアップロードにアップロードします。autoPEEP 患者として指定)。</li>
	<li>どこに教員を観察ケースを各学習者の各駅で重要なアクション チェックリストを設定します。これは、一方向のガラスの後ろにまたはベッドサイド テーブルの上があります十分な距離で、学習者はチェックリストを読むできません。各ステーションに一つの教員を割り当てます。</li>
	<li>景況感調査結果、認知の試験、および重要なアクション チェックリストに使用する 4 桁の識別コードを選ぶ各学習者があります。コードは、匿名で収集したデータを確認する使用ことがあります。学習者は、彼らは一貫してカリキュラムを通して覚えて任意の 4 桁コードを選択できます。</li>
	<li>別の部屋で学習する 5 分事前景況感調査を管理します。その終了時に学習者に 25 分プリテスト認知多肢選択試験を管理します。</li>
	<li>駅は、各駅で現在ある学習者に学習のレポートを持っています。残りの学生は別の部屋で待つ可能性があります。ある学習者を彼らの重要なアクションのチェックリストの教員に、4 桁の識別コードを提供します。</li>
	<li>学習ケースの幹を読み取り部があります。シナリオを介して動作するように駅あたりの学習者 10 分の最大を許可します。ケースの中にフィードバックを管理しないでください。シナリオの最後では、自分の部屋に戻って学習を却下します。</li>
	<li>各ケースの完了時に各学習者の重要なアクション チェックリスト記入部があります。すべての学習者は、すべてのステーションが完了するまで、すべての局による学習者を個別に回転します。紙や電子メールを介して学習する補足的な測定値を配布します。</li>
</ol>2 日 2-カリキュラムと教育的介入
<ol><li>上記のようにモニター、人工呼吸器、呼吸シミュレータ人間患者シミュレータと 5 つの局を設定します。</li>
	<li>次のトピックのいずれかの各ステーションに割り当てる: ARDS 無気肺粘液プラグ、気胸、続発変更薬物の過剰摂取と動的超インフレに二次的精神状態。2 つまたは 3 人のグループで学習者を配置します。各ステーションに一つの教員を割り当てます。</li>
	<li>できるように各チームのケースのシナリオで作業する 10 分。教員のフィードバック、ベッドサイドの命令を提供するために 35 分。残りの 4 つのステーションを介して学習を回転させます。</li>
</ol>3 日 3-ポスト試験の評価
<ol><li>重要なアクション チェックリスト、ポストテスト景況感調査結果、事後テスト認知多肢選択試験を印刷します。上記のようにモニター、人工呼吸器、呼吸シミュレータ人間患者シミュレータと 3 つの駅を設定します。次のトピックのいずれかの各ステーションに割り当てる: ARDS 無気肺気胸に接続する、粘液にセカンダリ。</li>
	<li>各症例のため動脈血ガス測定、心電図、ポータブル胸部 x 線像のバイタル サインを各それぞれ患者モニター (例えば、autoPEEP、autoPEEP として指定人間患者シミュレータに画像をアップロードにアップロードします。患者)。</li>
	<li>各学習者の各ステーションの重要なアクション チェックリストを設定します。各ステーションに一つの教員を割り当てます。5 分後テスト景況感調査および 25 分ポストテスト認知の多肢選択式試験を管理します。</li>
	<li>駅は、各駅で現在ある学習者に学習のレポートを持っています。残りの学生は別の部屋で待つ可能性があります。ある学習者を彼らの重要なアクションのチェックリストの教員に、4 桁の識別コードを提供します。</li>
	<li>学習ケースの幹を読み取り部があります。シナリオを介して動作するように駅あたりの学習者 10 分の最大を許可します。ケースの中にフィードバックを管理しないでください。シナリオの最後では、自分の部屋に戻って学習を却下します。</li>
	<li>各ケースの完了時に各学習者の重要なアクション チェックリスト記入部があります。すべての学習者は、すべてのステーションが完了するまで、すべての局による学習者を個別に回転します。すべての学習者に 10 分後教育カリキュラムを管理します。</li>
</ol>

<ol>
	<li>Slutsky, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=History+of+mechanical+ventilation.+From+vesalius+to+ventilator-induced+lung+injury.">History of mechanical ventilation. From vesalius to ventilator-induced lung injury.</a> Am J Respir Crit Care Med. 191 (10), 1106-1115 (2015).</li><li>Ahmed, N., Devitt, K. S., Keshet, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Systematic+Review+of+the+Effects+of+Resident+Duty+Hour+Restrictions+in+Surgery.">A Systematic Review of the Effects of Resident Duty Hour Restrictions in Surgery.</a> Ann Surg. 259 (6), 1041-1053 (2014).</li><li>Ziv, A., Wolpe, P. R., Small, S. D., Glick, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-Based+Medical+Education:+An+Ethical+Imperative.">Simulation-Based Medical Education: An Ethical Imperative.</a> Acad Med. 78 (8), 783-788 (2003).</li><li>Duwat, A., Hubert, V., Deransy, R., Dupont, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Difficult+airway+management:+assessment+of+knowledge+and+experience+in+anaesthesiology+residents.">Difficult airway management: assessment of knowledge and experience in anaesthesiology residents.</a> Ann Fr Anesth Reanim. 32 (40), 231-234 (2013).</li><li>Lee, M. O., Brown, L. L., Bender, J., Machan, J. T., Overly, F. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+medical+simulation-based+educational+intervention+for+emergency+medicine+residents+in+neonatal+resuscitation.">A medical simulation-based educational intervention for emergency medicine residents in neonatal resuscitation.</a> Acad Emerg Med. 19 (5), 577-585 (2012).</li><li>Barsuk, J. H., Cohen, E. R., Caprio, T., McGaghie, W. C., Simuni, T., Wayne, D. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+education+with+mastery+learning+improves+residents'+lumbar+puncture+skills.">Simulation-based education with mastery learning improves residents' lumbar puncture skills.</a> Neurology. 79 (2), 132-137 (2012).</li><li>Barsuk, J. H., Cohen, E. R., Vozenilek, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+education+with+mastery+learning+improves+paracentesis+skills.">Simulation-based education with mastery learning improves paracentesis skills.</a> J Grad Med Educ. 4 (1), 23-27 (2012).</li><li>Sohmer, B., Hudson, C., Hudson, J., Posner, G. D., Naik, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transesophageal+echocardiography+simulation+is+an+effective+tool+in+teaching+psychomotor+skills+to+novice+echocardiographers.">Transesophageal echocardiography simulation is an effective tool in teaching psychomotor skills to novice echocardiographers.</a> Can J Anaesth. 61 (3), 235-241 (2014).</li><li>Sigounas, V. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+simulation-based+training+model+on+vascular+anastomotic+skills+for+surgical+residents.">Evaluation of simulation-based training model on vascular anastomotic skills for surgical residents.</a> Simul Healthc. 7 (6), 334-338 (2012).</li><li>Dawe, S. R., Windsor, J. A., Broeders, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+surgical+skills+transfer+after+simulation-based+training:+laparoscopic+cholecystectomy+and+endoscopy.">A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy.</a> Ann Surg. 259 (2), 236-248 (2014).</li><li>Spadaro, S., Karbing, D. S., Fogagnolo, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation+Training+for+Residents+Focused+on+Mechanical+Ventilation.">Simulation Training for Residents Focused on Mechanical Ventilation.</a> Simul Healthc. , (2017).</li><li>Yee, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+Ventilation+Boot+Camp:+A+Simulation-Based+Pilot+Study.">Mechanical Ventilation Boot Camp: A Simulation-Based Pilot Study.</a> Crit Care Res Pract. 2016, (2016).</li><li>Ryoo, E. N., Ha, E. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Importance+of+Debriefing+in+Simulation-Based+Learning:+Comparison+Between+Debriefing+and+No+Debriefing.">The Importance of Debriefing in Simulation-Based Learning: Comparison Between Debriefing and No Debriefing.</a> Comput Inform Nurs. 33 (12), 538-545 (2015).</li><li>Shinnick, M. A., Woo, M., Horwich, T. B., Steadman, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Debriefing:+The+Most+Important+Component+in+Simulation?.">Debriefing: The Most Important Component in Simulation?.</a> Clin Simul Nurs. 7 (3), e105-e111 (2011).</li></ol>

著者が明らかに何もありません。

ブート キャンプは、3 つの別々 のセッションで構成されています。最初の日中に学習の事前テスト完了 5 分シナリオを受ける前に景況感調査と医療の知識をテストします。教員は、あらかじめ決められた重要なアクションを使用して学習者を評価します。学習者は、2 日前に完了する非同期読み取りを与えられています。2 日目は、2-3 学習者のグループが異なる 5 つのシナリオを介して動作?...

このブート キャンプは、住民の人工呼吸器のアラームのトラブルシューティングし同様に機械的に換気の患者を管理する方法を教えるために開発されました。この患者集団の管理は批判的に病気の患者の経験を制限している初心者の医師に威圧的な可能性があります。ベッドサイドで重要な介護の原則を教えるは国立作業時間制限1,2、および米国の法医学的懸念3によってより困難行われます。シミュレーションが開発し、侵襲的処置6,7,8,9,10 と同様に、救命スキル4,5を改良する効果的なモダリティ.シミュレーションを通じて学習者は、その医学的意思決定の結果が患者を危険にさらすことがなく、経験があります。このカリキュラムは、異なる学習モダリティ、intensivist、人工呼吸器の実践練習からベッドサイド教育補足の非同期読み取りなどの様々 なことができます。
以前の研究では、機械換気11,12のマネキン ベースの教育と知識の増加を示しています。Spadaroら11は、機械換気のシミュレーション教材を受けて麻酔住民のマネキン ベースのトレーニングとコンピューター ベースのトレーニングを比較しました。マネキン ベースのトレーニングを受けた住民より高いキー アクションとグローバル評価スコアを持っていた。私たちの以前の研究12で述べたように、最初の年の住民は知識の向上、信頼、そして能力を示したこのブート キャンプ ・ カリキュラムの結論の後。
書き込まれると、この 3 日間のカリキュラムは最初 1 日目の学習者の基本知識の評価し同様に 3 日目のカリキュラム完了時に自信を持って、知識、能力の変更を評価教育のためことができます。1 と 3 の日は、2 日目はコンテンツの専門家によるベッドサイド教育に焦点を当てながら評価に向けて専念しています。精神状態の変調駅が指導中に追加されたときに初期評価とテストの最後の日の使用された病態 (急性呼吸窮迫症候群 [ARDS] 無気肺粘液を差し込むと気胸にセカンダリ)人工呼吸器の基本を確認する日。動的なハイパー インフレは、人工呼吸器診断と高原圧力患者の考察を含む管理を強化する教育の日にも追加されました。彼らは教育ニーズに適切な感じとして、教育者は病態を代えることができます。
準備、シミュレーション部開催、最初リハーサル日すべて参加している教育者は彼らの役割を知っていたことを確認し、装置が適切に働いていた。評価、クリティカルケア医師教育のためのシミュレーション教員を採用しました、教育者は、リソースをディクテーションする教員の役割を調整できます。このブート キャンプの実行準備物流計画が必要です。最初の年の住民は、カリキュラムの 3 日間すべてを完了することができます保護された時間をする必要があります。集中治療は、ベッドサイド教育のセッションに出席するため、事前にオフ時間をスケジュールする必要があります。シミュレータ、機械的人工呼吸器と人間患者シミュレータ呼吸などのシミュレーション機器を購入、レンタル、または借りて必要があります。

<table border="0" cellpadding="0" cellspacing="0" style="width:517px;" width="518">
	<tbody>
		<tr height="107">
			<td height="107" style="height:107px;width:71px;">Puritan Bennett 840 Ventilator</td>
			<td style="width:71px;">Medtronic</td>
			<td style="width:71px;">4-840120EMC-01</td>
			<td style="width:305px;">http://www.medtronic.com/covidien/en-us/products/acute-care-ventilation/puritan-bennett-pb840-ventilator.html</td>
		</tr>
		<tr height="107">
			<td height="107" style="height:107px;width:71px;">ASL 5000 Breathing Simulator&#160;</td>
			<td style="width:71px;">IngMar</td>
			<td style="width:71px;">31 00 117</td>
			<td>https://www.ingmarmed.com/</td>
		</tr>
		<tr height="43">
			<td height="43" style="height:43px;width:71px;">Smart Stat Basic&#160;</td>
			<td style="width:71px;">Simulaids</td>
			<td style="width:71px;">101-8002</td>
			<td>https://www.simulaids.com/product/101-8002</td>
		</tr>
	</tbody>
</table>

mechanical ventilation boot camp curriculum

機械的に換気された患者の医学的管理が初心者プロバイダーへの挑戦です。この人口の不適切な管理は、増加罹患率と死亡率につながる可能性があります。3 日間シミュレーション ベースのブート キャンプは救命救急プロバイダーと一対一の命令を提供するために提供しています。これらの集中治療リアル人工呼吸器の実践的な練習で従事する学習パーソナライズされた即時フィードバックを分配することがあります。複数の異なる病態を確認できることは臨床設定でいない発生可能性があります。学習者は彼らの行動の即時の結果を可視化はできます、トラブルシューティングおよび質問すべてが、安全な学習環境と可能性があります。人間患者シミュレータ呼吸シミュレータと機械的人工呼吸器に接続しての利用について述べる。機器と専用ブート キャンプの実行に必要な時間のコストの潜在的なカリキュラム執行必要があります。ただし、この集中的な対話型トレーニングは、プロバイダーの能力、知識、および人工呼吸管理に自信を増加する示されています。このカリキュラムの概要では、機械的に換気された患者の管理上のプロバイダーを訓練するシミュレーション ベースのブート キャンプを実行する方法について説明します。

イーらで書きとめたので、このブート キャンプを受けた初年度住民は大幅に改善されたパフォーマンス、知識、自信の12を示した。前と後の介入によって認知的知識の評価平均スコアの 40.3% から 67.1%、+26.8 のスコアの平均変化から増加した複数の選択テスト % (図 1)。
重要な...

Watch this Scientific Journal Video about Mechanical Ventilation Boot Camp Curriculum at JoVE.com

Mechanical Ventilation Boot Camp Curriculum

このカリキュラムでは、シミュレーション ベースのブート キャンプをプロバイダーに機械的に換気された患者を管理する方法を教えることを実行する方法について説明します。

換気ブート キャンプ ・ カリキュラム

Medical management of mechanically ventilated patients is challenging to novice providers. Incorrect management of this population may lead to increased ...

mechanical-ventilation-boot-camp-curriculum

Research

Education

JoVE Core

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Medical-Surgical Nursing

Medicine

Unit 1

Fundamentals of Respiratory Care: Techniques and Management

SCIENTISTS IN ACTION

10.0K ビュー.  The Ohio State University. このカリキュラムでは、シミュレーション ベースのブート キャンプをプロバイダーに機械的に換気された患者を管理する方法を教えることを実行する方法について説明します。

ビデオ: Mechanical Ventilation Boot Camp Curriculum

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which works especially well with poor mask fit.
Can not intubate, can not ventilate" (CICV) is a potentially life threatening situation. In this video we present a simulation of the technique we used in a case of CICV where oxygenation and ventilation were maintained by inserting an endotracheal tube (ETT) nasally down to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.
A 13 year old patient was taken to the operating room for incision and drainage of a neck abcess and direct laryngobronchoscopy. After preoxygenation, anesthesia was induced intravenously. Mask ventilation was found to be extremely difficult because of the swelling of the soft tissue. The face mask could not fit properly on the face due to significant facial swelling as well. A direct laryngoscopy was attempted with no visualization of the larynx. Oxygen saturation was difficult to maintain, with saturations falling to 80%. In order to oxygenate and ventilate the patient, an endotracheal tube was then inserted nasally after nasal spray with nasal decongestant and lubricant. The tube was pushed gently and blindly into the hypopharynx. The mouth and nose of the patient were sealed by hand and positive pressure ventilation was possible with 100% O2 with good oxygen saturation during that period of time. Once the patient was stable and well sedated, a rigid bronchoscope was introduced by the otolaryngologist showing extensive subglottic and epiglottic edema, and a mass effect from the abscess, contributing to the airway compromise. The airway was secured with an ETT tube by the otolaryngologist.This video will show a simulation of the technique on a patient undergoing general anesthesia for dental restorations.

We describe a technique to maintain oxygenation and ventilation using an endotracheal tube inserted nasally to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation.

難しい挿管と困難な換気のための新規のレスキューテクニック

We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which ...

医学

Pressure Controlled Ventilation to Induce Acute Lung Injury in Mice

Murine models are extensively used to investigate acute injuries of different organs systems (1-34). Acute lung injury (ALI), which occurs with prolonged mechanical ventilation, contributes to morbidity and mortality of critical illness, and studies on novel genetic or pharmacological targets are areas of intense investigation (1-3, 5, 8, 26, 30, 33-36). ALI is defined by the acute onset of the disease, which leads to non-cardiac pulmonary edema and subsequent impairment of pulmonary gas exchange (36). We have developed a murine model of ALI by using a pressure-controlled ventilation to induce ventilator-induced lung injury (2). For this purpose, C57BL/6 mice are anesthetized and a tracheotomy is performed followed by induction of ALI via mechanical ventilation. Mice are ventilated in a pressure-controlled setting with an inspiratory peak pressure of 45 mbar over 1 - 3 hours. As outcome parameters, pulmonary edema (wet-to-dry ratio), bronchoalveolar fluid albumin content, bronchoalveolar fluid and pulmonary tissue myeloperoxidase content and pulmonary gas exchange are assessed (2). Using this technique we could show that it sufficiently induces acute lung inflammation and can distinguish between different treatment groups or genotypes (1-3, 5). Therefore this technique may be helpful for researchers who pursue molecular mechanisms involved in ALI using a genetic approach in mice with gene-targeted deletion.

A murine model for ventilator induced lung injury is an important tool to study an acute lung injury in vivo. Here, we report an easy applicable in situ model for acute lung injury using high-pressure mechanical ventilation to induce acute failure of the lung.

マウスにおける急性肺障害を誘発するために圧力制御された換気

Murine models are extensively used to investigate acute injuries of different organs systems (1-34). Acute lung injury (ALI), which occurs with prolonged ...

Repeated Measurement of Respiratory Muscle Activity and Ventilation in Mouse Models of Neuromuscular Disease

Accessory respiratory muscles help to maintain ventilation when diaphragm function is impaired. The following protocol describes a method for repeated measurements over weeks or months of accessory respiratory muscle activity while simultaneously measuring ventilation in a non-anesthetized, freely behaving mouse. The technique includes the surgical implantation of a radio transmitter and the insertion of electrode leads into the scalene and trapezius muscles to measure the electromyogram activity of these inspiratory muscles. Ventilation is measured by whole-body plethysmography, and animal movement is assessed by video and is synchronized with electromyogram activity. Measurements of muscle activity and ventilation in a mouse model of amyotrophic lateral sclerosis are presented to show how this tool can be used to investigate how respiratory muscle activity changes over time and to assess the impact of muscle activity on ventilation. The described methods can easily be adapted to measure the activity of other muscles or to assess accessory respiratory muscle activity in additional mouse models of disease or injury.

This paper introduces a method for repeated measurements of ventilation and respiratory muscle activity in a freely behaving amyotrophic lateral sclerosis (ALS) mouse model throughout disease progression with whole-body plethysmography and electromyography via an implanted telemetry device.

神経筋疾患のマウスモデルにおいて呼吸筋活動および換気の繰り返し測定

Accessory respiratory muscles help to maintain ventilation when diaphragm function is impaired. The following protocol describes a method for repeated ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.

This training platform is designed to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of the robotic system. Training includes the utilization of the technology and equipment to perform an emergency undocking, as well as delineation of roles for such a scenario.

ロボット手術の緊急ドッキング解除: シミュレーション カリキュラム

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Mechanical Micronization of Lipoaspirates for Regenerative Therapy

Stromal vascular fraction (SVF) has become a regenerative tool for various diseases; however, legislation strictly regulates the clinical application of cell products using collagenase. Here, we present a protocol to generate an injectable mixture of SVF cells and native extracellular matrix from adipose tissue by a purely mechanical process. Lipoaspirates are put into a centrifuge and spun at 1,200 x g for 3 min. The middle layer is collected and separated into two layers (high-density fat at the bottom and low-density fat on the top). The upper layer is directly emulsified by intersyringe shifting, at a rate of 20 mL/s for 6x to 8x. The emulsified fat is centrifuged at 2,000 x g for 3 min, and the sticky substance under the oil layer is collected and defined as the extracellular matrix (ECM)/SVF-gel. The oil on the top layer is collected. Approximately 5 mL of oil is added to 15 mL of high-density fat and emulsified by intersyringe shifting, at a rate of 20 mL/s for 6x to 8x. The emulsified fat is centrifuged at 2,000 x g for 3 min, and the sticky substance is also ECM/SVF-gel. After the transplantation of the ECM/SVF-gel into nude mice, the graft is harvested and assessed by histologic examination. The result shows that this product has the potential to regenerate into normal adipose tissue. This procedure is a simple, effective mechanical dissociation procedure to condense the SVF cells embedded in their natural supportive ECM for regenerative purposes.

Here, we present a protocol to obtain stromal vascular fraction from adipose tissue through a series of mechanical processes, which include emulsification and multiple centrifugations.

成人再生療法のための機械的微細化

Stromal vascular fraction (SVF) has become a regenerative tool for various diseases; however, legislation strictly regulates the clinical application of ...

Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum

Death notification is an important and challenging aspect of Emergency Medicine. An Emergency Medicine physician must deliver bad news, often sudden and unexpected, to patients and family members without any previous relationship. Unskilled death notification after unexpected events can lead to the development of pathologic grief and posttraumatic stress disorder. It is paramount for Emergency Medicine physicians to be trained in and practice death notification techniques. The GRIEV_ING curriculum provides a conceptual framework for death notification. The curriculum has demonstrated improvement in learners&#8217; confidence and competence when delivering bad news. Rapid Cycle Deliberate Practice is a simulation-based medical education technique that uses within the scenario debriefing. This technique uses the concepts of mastery learning and deliberate practice. It allows educators to pause a scenario, provide directed feedback, and then let learners continue the simulation scenario the &#8220;right way.&#8221; The purpose of this scholarly work is to describe how to apply the Rapid Cycle Deliberate Practice debriefing technique to the GRIEV_ING death notification curriculum to more effectively train learners in the delivery of bad news.

The goal is to demonstrate how to apply the rapid cycle deliberate practice debriefing technique to the GRIEV_ING death notification curriculum.

ラピッドサイクルの設定と実行は、実践死亡通知カリキュラムを実践する

Death notification is an important and challenging aspect of Emergency Medicine. An Emergency Medicine physician must deliver bad news, often sudden and ...

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

Lung transplantation (LTx) remains the standard of care for end-stage lung disease. A shortage of suitable donor organs and concerns over donor organ quality exacerbated by excessive geographic transportation distance and stringent donor organ acceptance criteria pose limitations to current LTx efforts. Ex situ lung perfusion (ESLP) is an innovative technology that has shown promise in attenuating these limitations. The physiologic ventilation and perfusion of the lungs outside of the inflammatory milieu of the donor body affords ESLP several advantages over traditional cold static preservation (CSP). There is evidence that negative pressure ventilation (NPV) ESLP is superior to positive pressure ventilation (PPV) ESLP, with PPV inducing more significant ventilator-induced lung injury, pro-inflammatory cytokine production, pulmonary edema, and bullae formation. The NPV advantage is perhaps due to the homogenous distribution of intrathoracic pressure across the entire lung surface. The clinical safety and feasibility of a custom NPV-ESLP device have been demonstrated in a recent clinical trial involving extender criteria donor (ECD) human lungs. Herein, the use of this custom device is described in a juvenile porcine model of normothermic NPV-ESLP over a 12 h duration, paying particular attention to management techniques. Pre-surgical preparation, including ESLP software initialization, priming, and de-airing of the ESLP circuit, and the addition of anti-thrombotic, anti-microbial, and anti-inflammatory agents, is specified. The intraoperative techniques of central line insertion, lung biopsy, exsanguination, blood collection, cardiectomy, and pneumonectomy are described. Furthermore, particular focus is paid to anesthetic considerations, with anesthesia induction, maintenance, and dynamic modifications outlined. The protocol also specifies the custom device's initialization, maintenance, and termination of perfusion and ventilation. Dynamic organ management techniques, including alterations in ventilation and metabolic parameters to optimize organ function, are thoroughly described. Finally, the physiological and metabolic assessment of lung function is characterized and depicted in the representative results.

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

This paper describes a porcine model of negative pressure ventilation ex situ lung perfusion, including procurement, attachment, and management on the custom-made platform. Focus is made on anesthetic and surgical techniques, as well as troubleshooting.

正常母性陰圧換気 ex situ 肺灌流:肺機能と代謝の評価

Lung transplantation (LTx) remains the standard of care for end-stage lung disease. A shortage of suitable donor organs and concerns over donor organ ...

Mechanical Control of Relaxation Using Intact Cardiac Trabeculae

Diastolic dysfunction is a common phenotype across cardiovascular disease presentations. In addition to elevated cardiac stiffness (elevated left ventricular end-diastolic pressure), impaired cardiac relaxation is a key diagnostic indicator of diastolic dysfunction. While relaxation requires the removal of cytosolic calcium and deactivation of sarcomeric thin filaments, targeting such mechanisms has yet to provide effective treatments. Mechanical mechanisms, such as blood pressure (i.e., afterload), have been theorized to modify relaxation. Recently, we showed that modifying the strain rate of a stretch, not afterload, was both necessary and sufficient to modify the subsequent relaxation rate of myocardial tissue. The strain rate dependence of relaxation, called the mechanical control of relaxation (MCR), can be assessed using intact cardiac trabeculae. This protocol describes the preparation of a small animal model, experimental system and chamber, isolation of the heart and subsequent isolation of a trabecula, preparation of the experimental chamber, and experimental and analysis protocols. Evidence for lengthening strains in the intact heart suggests that MCR might provide new arenas for better characterization of pharmacological treatments, along with a method to assess myofilament kinetics in intact muscles. Therefore, studying the MCR may elucidate a path to novel approaches and new frontiers in the treatment of heart failure.

Rapid myocardial and cardiac relaxation is essential for normal physiology. Mechanical relaxation mechanisms are now known to be dependent on strain rate. This protocol provides an overview of the acquisition and analysis of experiments to further study the mechanical control of relaxation.

無傷の心臓小柱を用いたリラクゼーションの機械的制御

Diastolic dysfunction is a common phenotype across cardiovascular disease presentations. In addition to elevated cardiac stiffness (elevated left ...

横隔膜の機能障害の評価と治療のモニタリングにおける超音波

Measuring Diaphragm Thickness and Function Using Point-of-Care Ultrasound

The diaphragm is the main component of the respiratory muscle pump. Diaphragm dysfunction can cause dyspnea and exercise intolerance, and predisposes affected individuals to respiratory failure. In mechanically ventilated patients, the diaphragm is susceptible to atrophy and dysfunction through disuse and other mechanisms. This contributes to failure to wean and poor long-term clinical outcomes. Point-of-care ultrasound provides a valid and reproducible method for evaluating diaphragm thickness and contractile activity (thickening fraction during inspiration) that can be readily employed by clinicians and researchers alike. This article presents best practices for measuring diaphragm thickness and quantifying diaphragm thickening during tidal breathing or maximal inspiration. Once mastered, this technique can be used to diagnose and prognosticate diaphragm dysfunction, and guide and monitor response to treatment over time in both healthy individuals and acute or chronically ill patients.

著者スポットライト:横隔膜機能と患者の転帰に対する人工呼吸器の影響を解明する 

Diaphragm thickness and function can be assessed in healthy individuals and critically ill patients using point-of-care ultrasound. This technique offers an accurate, reproducible, feasible, and well-tolerated method for evaluating diaphragm structure and function.

ポイントオブケア超音波を用いたダイアフラムの厚さと機能の測定

The diaphragm is the main component of the respiratory muscle pump. Diaphragm dysfunction can cause dyspnea and exercise intolerance, and predisposes ...

換気ブート キャンプ ・ カリキュラム

換気ブートキャンプ・カリキュラム