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Intraoperative Sepsis: A Simulation Case for Anesthesiology Residents
Timothy T Webb1, Tanna J Boyer1,2, Sally A Mitchell1,3,4
1Assistant Professor of Clinical Anesthesia, Department of Anesthesia, Indiana University School of Medicine.
Mededportal : the Journal of Teaching and Learning Resources
|March 25, 2020
Summary
Anesthesiology residents improved septic shock management through a simulation focusing on critical actions like fluid resuscitation and invasive line use. This training is vital for intraoperative patient care during sepsis events.
Area of Science:
- Medical Education
- Critical Care Medicine
- Anesthesiology
Background:
- Sepsis and septic shock are leading causes of mortality, necessitating expert management in intensive care units (ICUs).
- Anesthesiology residency training must equip residents with skills for critical care, particularly managing intraoperative septic shock.
- Understanding sepsis presentation and treatment is fundamental for safe patient care during surgery.
Purpose of the Study:
- To evaluate the effectiveness of a simulation-based training program for anesthesiology residents in managing intraoperative septic shock.
- To identify common critical actions missed by residents during septic shock management scenarios.
- To enhance resident preparedness for rare but life-threatening events like acute septic shock in the operating room.
Main Methods:
- A simulation scenario involving a patient with peripancreatic cyst debridement, hemodynamic instability, and septic shock was developed.
- Year 2 anesthesiology residents (n=26) participated in yearly 1-hour simulation sessions.
- The simulation covered key Anesthesiology Milestones related to sepsis and septic shock.
Main Results:
- 155 residents completed the simulation, with common errors including delays in recognizing the need for invasive lines and appropriate fluid resuscitation.
- Participants often missed critical steps such as inquiring about blood cultures and antibiotics.
- Most residents could diagnose and treat intraoperative septic shock, but all benefited from debriefing and identifying areas for improvement.
Conclusions:
- Simulation provides an optimal platform for practicing rare and critical clinical events like intraoperative septic shock.
- This simulation effectively reinforced current sepsis definitions and evidence-based treatment guidelines for residents.
- The training scenario proved valuable for identifying and addressing specific deficits in residents' management of septic shock.
