Table 2.
Table 2. Description of Pulmonary Scenarios: Each of the 5 Scenarios Used during the Pulmonary Graphical Display Study Are Described Above. The METI Simulator Was Programmed, the Anesthesia Machines Were Adjusted, and/or the Endotracheal Tube Was Adjusted to Create Each of the Scenarios
| Scenario | Description |
|---|---|
| Obstructed endotracheal tube | Increased upper airway resistance from 12 cmH2O/l/s to 1000 cmH2O/l/s over 5 minutes |
| An airway obstruction element that progressed through low (greater than 3 cmH2O/l/s), medium greater than 12.5 cmH2O/l/s), and high (greater than 25 cmH2O/l/s) airway resistance over 5 minutes | |
| Endobronchial intubation | The distal end of the endotracheal tube was inserted to 28cm measured at the teeth to create a right mainstem intubation |
| Verification of endotracheal tube placement in the right mainstem was done prior to starting the scenario by observing decreased left sided chest rise and decreased breath sounds over the left lung field | |
| Breath sounds were diminished over the left lung field, peak inspiratory pressures were elevated, and airway resistance was increased when the clinician volunteers attempted manual ventilation | |
| The graphical pulmonary display showed a decrease in lung compliance by the appearance of a thickened black cage surrounding the lung objects | |
| Intrinsic PEEP | The inspiratory to expiratory (I:E) ratio on the ventilator was set to 1:1 |
| The anesthesia monitors correspondingly showed shorter expiratory times on the pressure and volume waveforms | |
| The graphical pulmonary display showed an expanded lung that represented the increased residual volume from breath stacking | |
| Hypoventilation | The ventilator bellows was set to deliver 500ml tidal volume |
| The positive inspired pressure limit on the ventilator was lowered until only a 250ml tidal volume was delivered | |
| The graphical pulmonary display showed a low tidal volume | |
| Normal | Selected “normal adult” in the METI simulator |
| The anesthesia monitors showed normal values | |
| The graphical pulmonary display showed all pulmonary variables within normal range | |
| Upon entering the simulation room, the volunteers were told by the resident that the patient was wheezing |