From the Department of Anaesthesia (J.C.H., H.L.E.), Stavanger University Hospital, Stavanger, Norway; Faculty of Health Sciences (J.C.H., S.I.R., H.L.E.), University of Stavanger, Stavanger, Norway; Department of Paediatrics (S.I.R.), Stavanger University Hospital, Stavanger, Norway; Department of Biostatistics (A.U.), Stavanger University Hospital, Stavanger, Norway; and Department of Pediatrics (J.M.P.), Weill Cornell Medicine, New York, NY.
Simul Healthc. 2024 Dec 1;19(6):341-349. doi: 10.1097/SIH.0000000000000783. Epub 2024 Mar 6.
Facemask ventilation is a crucial, but challenging, element of neonatal resuscitation.In a previously reported study, instructor-led training using a novel neonatal simulator resulted in high-level ventilation competence for health care providers (HCPs) involved in newborn resuscitation. The aim of this study was to identify the optimal frequency and dose of simulation training to maintain this competence level.
Prospective observational study of HCPs training through 9 months. All training was logged. Overall ventilation competence scores were calculated for each simulation case, incorporating 7 skill elements considered important for effective ventilation.Overall scores and skill elements were analyzed by generalized linear mixed effects models using frequency (number of months of 9 where training occurred and total number of training sessions in 9 months) and dose (total number of cases performed) as predictors. Training loads (frequency + dose) predictive of high scores were projected based on estimated marginal probabilities of successful outcomes.
A total of 156 HCPs performed 4348 training cases. Performing 5 or more sessions in 9 months predicted high global competence scores (>28/30). Frequency was the best predictor for 4 skill elements; success in maintaining airway patency and ventilation fraction was predicted by performing training in, respectively, 2 and 3 months of 9, whereas for avoiding dangerously high inflating pressures and providing adequate mask seal, 5 and 6 sessions, respectively, over the 9 months, predicted success. Skills reflecting global performance (successful resuscitation and valid ventilations) and ventilation rate were more dose-dependent.
Training frequency is important in maintaining neonatal ventilation competence. Training dose is important for some skill elements. This offers the potential for individualized training schedules.
面罩通气是新生儿复苏的关键但具有挑战性的环节。在之前的一项研究中，使用新型新生儿模拟器进行的带教式培训使参与新生儿复苏的医护人员（HCP）具备了高水平的通气能力。本研究旨在确定维持这种能力水平的最佳模拟培训频率和剂量。
前瞻性观察性研究 HCP 在 9 个月内的培训情况。所有培训均有记录。每个模拟案例的总体通气能力评分均进行计算，纳入 7 项被认为对有效通气很重要的技能要素。使用广义线性混合效应模型分析总体评分和技能要素，将频率（进行培训的 9 个月中的月份数和 9 个月内的总培训次数）和剂量（完成的总例数）作为预测因素。基于成功结果的估计边际概率，预测具有高得分的培训负荷（频率+剂量）。
共有 156 名 HCP 完成了 4348 例培训。9 个月内进行 5 次或以上培训可预测总体能力评分较高（>28/30）。频率是 4 项技能要素的最佳预测因素；分别在 9 个月中的 2 个月和 3 个月进行培训可成功维持气道通畅性和通气分数，而要避免充气压力过高和提供足够的面罩密封，则需要分别在 9 个月内进行 5 次和 6 次培训。反映总体表现（成功复苏和有效通气）和通气率的技能更依赖于剂量。
培训频率对于维持新生儿通气能力很重要。培训剂量对于某些技能要素很重要。这为个体化培训计划提供了潜力。
