AJ VŠEOBECNÍ LEKÁRI SI BUDÚ MÔCŤ AKTUALIZOVAŤ PROFESNÉ KOMPETENCIE POMOCOU MEDICÍNSKYCH SIMULÁTOROV (VÝHODY A ÚSKALIA)

Dramatic increase in health information, higher requirements on patient safety, processing and storing data, facts which put new requirements on curriculum restructuring, giving priority to teaching in small groups and e-learning, as well as support to independent research, have intensified the need of quest for new motivation in educating health care professionals (GP KEGA MŠVVaŠ SR č.052-4/2013). Nevertheless, in spite of all efforts to introduce contextual education, there is still a gap between theoretical and clinical environments. A large percentage of students have the feeling that they are not trained enough in determining anamneses, physical check ups, diagnostics and management of health care. It is expected that introducing medical simulations into current curricula will bridge this gap

Six methods to determine expiratory time constants in mechanically ventilated patients: a prospective observational physiology study

Abstract Background Expiratory time constant (τ) objectively assesses the speed of exhalation and can guide adjustments of the respiratory rate and the I:E ratio with the goal of achieving complete exhalation. Multiple methods of obtaining τ are available, but they have not been compared. The purpose of this study was to compare six different methods to obtain τ and to test if the exponentially decaying flow corresponds to the measured time constants. Methods In this prospective study, pressure, flow, and volume waveforms of 30 postoperative patients undergoing volume (VCV) and pressure-controlled ventilation (PCV) were obtained using a data acquisition device and analyzed. τ was measured as the first 63% of the exhaled tidal volume (VT) and compared to the calculated τ as the product of expiratory resistance (RE) and respiratory system compliance (CRS), or τ derived from passive flow/volume waveforms using previously published equations as proposed by Aerts, Brunner, Guttmann, and Lourens. We tested if the duration of exponentially decaying flow during exhalation corresponded to the duration of the predicted second and third τ, based on multiples of the first measured τ. Results Mean (95% CI) measured τ was 0.59 (0.57–0.62) s and 0.60 (0.58–0.63) s for PCV and VCV (p = 0.45), respectively. Aerts method showed the shortest values of all methods for both modes: 0.57 (0.54–0.59) s for PCV and 0.58 (0.55–0.61) s for VCV. Calculated (CRS * RE) and Brunner’s τ were identical with mean τ of 0.64 (0.61–0.67) s for PCV and 0.66 (0.63–069) s for VCV. Mean Guttmann’s τ was 0.64 (0.61–0.68) in PCV and 0.65 (0.62–0.69) in VCV. Comparison of each τ method between PCV and VCV was not significant. Predicted time to exhale 95% of the VT (i.e., 3*τ) was 1.77 (1.70–1.84) s for PCV and 1.80 (1.73–1.88) s for VCV, which was significantly longer than measured values: 1.27 (1.22–1.32) for PCV and 1.30 (1.25–1.35) s for VCV (p < 0.0001). The first, the second and the third measured τ were progressively shorter: 0.6, 0.4 and 0.3 s, in both ventilation modes (p < 0.0001). Conclusion All six methods to determine τ show similar values and are feasible in postoperative mechanically ventilated patients in both PCV and VCV modes