Perspectives on Current Mechanical Ventilation Use and Training in Pediatric Critical Care Medicine Fellowship Programs in the United States

Abstract

Mechanical ventilation (MV) is an integral part of the care of the critically ill child, and contemporary MV includes a myriad of sophisticated modalities that should be tailored to specific disease pathology and severity. This requires Pediatric Critical Care Medicine (PCCM) physicians to have comprehensive training and experience with various modes. We sought to assess and describe the current landscape of MV practices and training from PCCM fellowship programs. To describe current MV practices and training in PCCM fellowship programs and assess the different modes of MV to which trainees are exposed, a piloted survey was sent to all 67 American PCCM fellowship program directors (PDs) in 2019. Forty-eight (71.6%) of PCCM PDs responded. Our survey shows that PCCM fellows are not uniformly exposed to the same MV modalities, and PDs' perception of fellows' competency in managing MV is variable. Our results suggest that there is a lack of exposure to the various modes of “conventional” MV, as well as inconsistent education about less-utilized “nonconventional” MV. Additionally, we found that PDs are aware of their fellows' limited exposure to various modalities, as many practice patterns are institution specific. This study identified gaps in MV education and training and advocates for PCCM fellowship programs to identify these deficiencies to equip all trainees with a solid knowledge base that will prepare them to utilize any mode of MV in their future practice.

Keywords

pediatric - training - Pediatric Critical Care Medicine - PICU - fellowship - mechanical ventilation

• References

• 1 Pham T, Brochard LJ, Slutsky AS. Mechanical ventilation: state of the art. Mayo Clin Proc 2017; 92 (09) 1382-1400
• 2 Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in pediatric critical care medicine. 2013 https://www.acgme.org/globalassets/pfassets/2013-pr-faq-pif/323_critical_care_peds_07012013.pdf
• 3 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
• 4 Rowley BD. AMA–Fellowship And Residency Electronic Interactive Database Access (AMA-FREIDA): a computerized residency selection tool. JAMA 1988; 260 (08) 1059
• 5 Balcells Ramírez J, López-Herce Cid J, Modesto Alapont V. Grupo de Respiratorio de la Sociedad Española de Cuidados Intensivos Pediátricos. [Prevalence of mechanical ventilation in pediatric intensive care units in Spain]. An Pediatr (Barc) 2004; 61 (06) 533-541 [pii]
• 6 Arca MJ, Uhing M, Wakeham M. Current concepts in acute respiratory support for neonates and children. Semin Pediatr Surg 2015; 24 (01) 2-7 [doi]
• 7 Ålander M, Peltoniemi O, Saarela T, Anttila E, Pokka T, Kontiokari T. Current trends in paediatric and neonatal ventilatory care—a nationwide survey. Acta Paediatr 2013; 102 (02) 123-128 [doi]
• 8 Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16 (05) 428-439 [doi]
• 9 Kneyber MCJ, de Luca D, Calderini E. et al; section Respiratory Failure of the European Society for Paediatric and Neonatal Intensive Care. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med 2017; 43 (12) 1764-1780 [doi]
• 10 Meligy BS, Kamal S, El Sherbini SA. Mechanical ventilation practice in Egyptian pediatric intensive care units. Electron Physician 2017; 9 (05) 4370-4377
• 11 Dani C, Lista G, Martano C, Messina F, Migliori C, Vento G. Italian survey of neonatal respiratory support strategies. J Matern Fetal Neonatal Med 2012; 25 (Suppl. 04) 66-67 [doi]
• 12 Dani C, Bresci C, Lista G. et al. Neonatal respiratory support strategies in the intensive care unit: an Italian survey. Eur J Pediatr 2013; 172 (03) 331-336 [doi]
• 13 Wolfler A, Calderoni E, Ottonello G. et al; SISPE Study Group. Daily practice of mechanical ventilation in Italian pediatric intensive care units: a prospective survey. Pediatr Crit Care Med 2011; 12 (02) 141-146
• 14 Grenier B, Thompson J. High-frequency oscillatory ventilation in pediatric patients. Respir Care Clin N Am 1996; 2 (04) 545-557
• 15 Ganesan SL. Airway pressure release ventilation in children. Curr Opin Crit Care 2019; 25 (01) 63-70 [doi]
• 16 Ganesan SL, Jayashree M. Reply to: airway pressure release ventilation: is it really different in adults and children?. Am J Respir Crit Care Med 2019; 200 (06) 789-790
• 17 Sinderby C, Navalesi P, Beck J. et al. Neural control of mechanical ventilation in respiratory failure. Nat Med 1999; 5 (12) 1433-1436
• 18 Hill DA, Lord RS. Complementary value of traditional bedside teaching and structured clinical teaching in introductory surgical studies. Med Educ 1991; 25 (06) 471-474