Driving Simulators – More than a Video Game!

Background: This study aimed to investigate teenager, young adult, and adult knowledge levels on distracted and impaired driving through the use of educational driving simulators. The distracted and impaired driving simulators were customized to instruct participants on the dangers of driving distracted or impaired utilizing consequence videos. The simulators were taken to high schools, colleges/universities, and businesses over a four year period where we hypothesized that they would play a significant role in raising knowledge about the dangers and penalties of these risky driving behaviors and would also help to increase seat belt usage. Setting: High schools, colleges / universities, and businesses in northeastern central Pennsylvania September 2012 through May 2016. Sample: 22,801 pre-surveys were taken by mainly students that participated through their high school. Methods: An electronic pre-survey was administered to all participants wanting to drive the simulators. The survey questions were designed to test the participant’s knowledge of driving distracted while driving alone or with somebody else, driving impaired while driving alone or with somebody else, and the use of a seat belt every time they get into a vehicle. Demographic information was collected prior to driving the simulators such as the driver’s age and gender. Based upon their driving outcome, the post survey collected data was based on which drive they did (distracted vs. impaired) and if they thought the consequences for their actions were what they thought they would be. Also questioned was how likely they were to wear their seat belt in the future. Results: In the 22,801 completed pre-surveys, males completed 53% of the surveys, females 47%. Participants of teen driver age (16 to 18) made up the largest number of participants at 49%, with 30% being of non-driver age, and 21% over age 18; 88% of participants have not or rarely checked e-mail or talked on the cell phone within the last 30 days while driving; while 44% have ridden with a driver that was frequently or occasionally texting, checking email, or talking on a cell phone while driving in the last 30 days. Understanding that impaired includes: alcohol, over the counter prescription or other drugs, and drowsy/overly tired, 95% have rarely or not driven impaired in the last 30 days and 95% reported rarely or never going to drive impaired in the future. Those who stated they always wear a seat belt when getting into a vehicle were 77%; however post survey reports showed in the future 87% said they would always wear a seat belt, a 10% gain in knowledge after their driving experience. Conclusions: Driving simulators used on new drivers showing real life consequences, does raise awareness about texting, cellphone use, impaired driving, and not wearing a seat belt. Sixty seven percent of the participants stated the consequences to driving distracted were worse or much worse than they thought

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

International audienceBackground: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society