Training activity information
Details
Advise a clinical colleague on the different types of spontaneous ventilation modes available on a mechanical ventilator and why these may be used clinically in a critical care environment
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Patient centred care and support
- Communication with patients, relatives and the clinical team
- Risk management
- Troubleshooting
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to advising a colleague on different spontaneous ventilation modes (e.g., CPAP, Pressure Support Ventilation (PSV), Mandatory Minute Ventilation (MMV)) and providing clinical rationale for their use in critical care.
- Consider how the learning outcomes apply, specifically in relation to appraising respiratory techniques, effectively communicating complex concepts and ensuring patient safety by correctly advising on mode usage for specific pathologies.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the specific spontaneous modes commonly used in your unit, and the depth of understanding required for clinical applications (e.g., linking PSV to weaning readiness).
What is your prior experience of this activity?
- Think about what you already know about spontaneous ventilation modes (e.g., CPAP, Pressure Support) and their underlying physiological principles.
- Consider possible challenges you might face during the activity, such as explaining the complex physiological differences between two modes (e.g., Proportional Assist Ventilation (PAV) vs. Neural Adjusted Ventilatory Assist (NAVA)) or tailoring advice to specific patient conditions (e.g., post-operative recovery vs. COPD exacerbation).
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if a colleague asks for advice on setting up a highly specialised or novel spontaneous mode not covered in routine ventilator protocols.
- Acknowledge how you feel about embarking on this training activity, particularly your confidence in explaining spontaneous ventilation modes and their complex clinical applications.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as improving your ability to clearly explain different spontaneous modes, their benefits, and indications (e.g., when to switch from A/C to PSV), drawing upon previous experiences.
- Identify the specific insights you hope to gain into the rationale for using one spontaneous mode over another in specific patient conditions (e.g., cardiac failure vs. post-operative recovery).
What additional considerations do you need to make?
- Consult actions identified following previous experiences of mechanical ventilation or advising colleagues on respiratory support.
- Identify important information you need to consider before embarking on the activity, such as reviewing the academic content on modes and patterns used in mechanical ventilation and the settings/mechanisms of common spontaneous modes on the ventilators in your unit.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst advising a colleague on spontaneous ventilation modes (e.g., PSV, MMV) and their clinical use in critical care?
- Are you encountering situations such as:
- The colleague asks about a newly implemented or rarely used spontaneous mode (e.g., PAV or NAVA) that you are less familiar with?
- The clinical scenario involves complex weaning challenges (e.g., failure to wean due to excessive spontaneous drive) that requires explaining the subtle differences between flow-triggered and pressure-triggered modes?
- Unexpected questions arise about specific ventilator settings (e.g., optimal pressure support level) that require real-time application of knowledge to the patient’s current physiology?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to explaining mode mechanics or applying physiological rationale?
- Consider the steps you are taking in the moment, such as:
- Immediately seeking clarification on the colleague’s clinical goal to ensure the advice provided is context-specific and safe
- Adapting your language to use non-technical analogies (e.g., comparing PSV to power steering) to simplify complex concepts for a novice colleague
- How are you feeling in that moment? For instance, are you finding it difficult to differentiate between mode advantages under complex respiratory mechanics? Is it affecting your confidence in addressing nuanced clinical questions about weaning?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully explaining the principles and common applications of spontaneous modes, linking them to patient stability? Or are you needing support because the request involves setting parameters for a highly unstable patient, requiring senior respiratory or clinical specialist oversight?
- What are you learning as a result of the unexpected development? For example, are you mastering the ability to explain complex physiological concepts simply? Or gaining insight into the specific clinical predictors used to select the optimal spontaneous weaning mode?
On action
What happened?
- Begin by summarising the key steps you took when advising the clinical colleague on spontaneous ventilation modes and their clinical use in critical care.
- Consider specific events, actions, or interactions which felt important, such as discussing the physiological difference between CPAP and Pressure Support or explaining how specific modes facilitate weaning.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, adjusting your explanation to focus on clinical rationale rather than technical settings when the colleague appeared confused by the complex terminology.
- How did you feel during this experience, e.g., did you feel confident in linking modes to patient pathophysiology or challenged by the simplicity required to explain a complex concept?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding advising colleagues on mechanical ventilation modes. What strengths did you demonstrate, e.g., ability to clearly articulate the indications for using Pressure Support Ventilation (PSV)?
- What skills and/or knowledge gaps were evident, e.g., gaps in your understanding of the nuances of Proportional Assist Ventilation (PAV)?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in simplifying complex concepts related to ventilation mechanics?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the optimal pressure support level for a patient with severe COPD exacerbation, and how you reacted to this.
- Acknowledge any changes in your own feelings now that you are looking back on the experience.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to reviewing academic content on less common spontaneous ventilation modes.
- What will you do differently next time you approach advising on spontaneous ventilation modes, for instance, by proactively drawing diagrams or graphs to illustrate the difference between modes like CPAP and PSV?
- Do you need to practise any aspect of the activity further, such as explaining the physiological basis of spontaneous modes or key learning outcomes related to appraising techniques for respiratory function?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of assisting with complex weaning trials requiring modes like mandatory minute ventilation (MMV) or NAVA since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, the ambiguity in setting pressure support ventilation (PSV) levels during a subsequent weaning attempt forced you to re-evaluate the physiological rationale you presented for mode selection during your first attempt at this training activity.
- Considering what you understand about patient-ventilator synchrony and respiratory muscle workload now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your advisory communication regarding the clinical application of spontaneous ventilation modes based on further learning and experiences? For example, how you proactively reviewed and integrated the criteria for patient readiness for specific spontaneous weaning modes (e.g., PSV) based on further learning.
- Has discussing the optimal use of CPAP versus pressure support or the impact of inappropriate spontaneous mode selection on diaphragmatic fatigue with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a respiratory specialist about a patient who failed extubation due to inadequate respiratory support mode settings refined your understanding of the critical nature of applying physiological principles to mode selection.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent advisory and clinical observation experiences, contributed to your overall confidence and ability in advising on the selection and clinical rationale of spontaneous ventilation modes, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated knowledge of PSV and CPAP physiological benefits now enables you to efficiently appraise the options of spontaneous ventilation modes with a clinical colleague during an OCE assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to advising colleagues on mechanical ventilation modes? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Respiratory Specialist immediately when asked to advise on complex parameter settings (e.g., setting optimal pressure support levels) for an unstable patient who is failing to wean, recognising this requires specialist setting adjustment.
- Looking holistically at your training journey, how has this initial spontaneous ventilation modes advisory experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to appraising techniques to maintain patient respiratory function and demonstrating effective communication? For example, how this foundational experience has supported your development in translating complex ventilator mechanics into clinically relevant advice for therapeutic decisions.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Appraise techniques to maintain patient respiratory function, advising on appropriate techniques for the clinical scenario. |
| # 5 |
Outcome
Communicate effectively with the patient and the multi-disciplinary team. |
| # 6 |
Outcome
Practice safely, managing risk in all elements of patient care. |