Managing ARDS in the Operating Room: A Timely Simulation for Anesthesiology Residents

Abstract

Introduction: Acute respiratory distress syndrome (ARDS) is a serious medical condition with high morbidity and mortality that frequently requires management in the intensive care unit (ICU). As critical care training is a vital component of anesthesiology residency and critically ill patients often require procedures necessitating anesthesia, understanding the presentation, management, and treatment of ARDS is essential to perioperative patient care. Educational Objectives: By the end of this simulation case, learners will be able to: identify and define ARDS; describe and apply ventilator strategies for patients with ARDS; and discuss strategies to improve oxygenation in patients with ARDS in addition to adjusting ventilator settings. Methods: This simulation involved a 66-year-old man with inhalational burn injuries undergoing debridement and homografting of burns in the operating room. During the case, the patient’s oxygenation and lung compliance demonstrated changes consistent with worsening ARDS. We conducted this simulation yearly for clinical anesthesia year 2 residents (CA2/PGY3; n=26) in 1-hour sessions with three to four learners at a time. The simulation covered five Anesthesiology Milestones related to ARDS as outlined in the Anesthesiology Milestones Project. Results: At the time of submission, 130 anesthesia residents completed the simulation. Commonly missed critical actions include failure to: recognize the need to adjust ventilator settings prior to inducing anesthesia; investigate causes of acute hypoxemia during the procedure; provide appropriate ventilator changes to improve the patient’s acute hypoxemia; and recognize the need to cancel the procedure. Most participants appropriately diagnosed and managed hypoxemia, and all agreed the simulation was a valuable learning experience. Conclusions: Simulation presents trainees with an effective opportunity to further their learning with regard to the recognition, management, and treatment of ARDS. This simulation provides an opportunity to discuss the currently evolving management of ARDS.