A Simulation-Based Approach to Severe Bronchospasm Complicated by Septic Shock

Recognizing and managing high-acuity, low-frequency pediatric conditions such as near-fatal bronchospasm with respiratory failure and uncompensated septic shock are essential skills for trainees. These emergencies require timely clinical judgment and familiarity with medications, respiratory support, and resuscitation strategies.

We implemented a high-fidelity, interprofessional simulation for pediatric residents focused on management of near-fatal bronchospasm complicated by septic shock. The simulation was delivered as 4 standalone sessions over 2 months. The scenario features a 2-year-old child presenting in respiratory distress due to pneumonia, who progresses to respiratory failure requiring BiPAP. He subsequently develops uncompensated septic shock necessitating fluid resuscitation and vasopressor support. Simulation materials included a structured prebrief, PEARLS-guided debrief, and a retrospective post-then-presimulation confidence survey.

Among 90 pediatric residents (32 PGY 1, 34 PGY 2, and 24 PGY 3/4), confidence scores significantly improved across all 3 objectives (each P < .01). For objectives 1, 2, and 3, perceived confidence improved at least one level in 62%, 67%, and 72% of residents, respectively. PGY-1 residents showed the most improvement overall, with significantly greater confidence gains compared with senior residents in implementing objective 2 (respiratory support escalation) (P = .004).

Following a high-fidelity simulation focused on management of near-fatal bronchospasm, respiratory failure, and uncompensated septic shock, pediatric residents reported increased confidence across all training levels in achieving the educational objectives. These outcomes align with Kirkpatrick Level 2 learning, supporting simulation as a valuable tool to enhance clinical confidence in recognizing and treating rare but life-threatening scenarios without patient risk.