The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Julianne S. Perretta1, Cheryl Meredith2, Daenna King2, Stacey Mann2, Elizabeth A. Hunt1,3; 1Simulation Center, Johns Hopkins Medicine, Baltimore, MD; 2Pediatric Respiratory Care Services, The Johns Hopkins Hospital, Baltimore, MD; 3The Johns Hopkins School of Medicine, Baltimore, MD

Background: All Pediatric Respiratory Therapists (RTs) are required to respond to pediatric rapid response team (PRRT) calls throughout the Johns Hopkins HospitalÂ’s Childrens Center. The most common reason for calling the PRRT is for infants with desaturation and respiratory distress or arrest. This requires rapid intervention to stabilize the airway and provide positive pressure ventilation (PPV) to prevent progression to cardiac arrest. Informal observation during PRRT suggests there is a broad variation in the competence level of this fundamental skill. Prior to introduction of a new educational curriculum, we assessed whether pediatric RTs who enter the room of a simulated infant mannequin in severe respiratory distress were able to: Apply PPV and attempt to move the chest within 60 seconds, and demonstrate at least 2 adjunctive airway maneuvers when initially unsuccessful with PPV within 120 seconds. Methods: All Pediatric RTs were required as part of their 2009 annual skills assessment to attend one high-fidelity simulation at the Johns Hopkins Medicine Simulation Center. Sessions were recorded for quality assurance purposes. Staff was assessed on their ability to respond to an infant in respiratory distress and debriefed on their performance immediately upon scenario conclusion. When all staff sessions were complete, videos were reviewed using a checklist of key performance measures. A subset of videos was assessed by 2 reviewers independently and inter-rater reliability was calculated. Results: Nineteen videos were reviewed. Only 2/19 (11%) met established time goals for PPV and one (5%) met the time goal for visible chest rise. However, 13/19(68%) provided 2 adjunctive airway maneuvers and obtained visible chest rise. The most common interventions when initial PPV was unsuccessful were repositioning the airway, 15/19 (79%) and oral airway insertion, 10/19 (53%). Only 4/19 (21%) utilized the key maneuver of two person PPV. Times to key performance measures are found in Table 1. Conclusion: This study revealed concerning deficits in fundamental airway skills of our pediatric RTs that may place critically ill children at risk of sub-optimal management and threaten their clinical outcomes. Adjustments will be made to subsequent training days to focus on quicker assessment of respiratory distress, meeting time goals for PPV, and a systematic algorithm for adjunctive airway maneuvers including rapid application of two person PPV. Sponsored Research - None