(1386) Mechanical Ventilation Training Standardization: International Modified DELPHI Survey

Introduction: Mechanical ventilation (MV) is a life sustaining intervention for critically ill patients with acute respiratory failure, necessitating meticulous assessment and management. Inconsistent MV practices (settings, monitoring, weaning, and extubation) highlight the need for a standardized approach to improve safety and adherence to best practices. This work focuses on gaining consensus on a structured bedside MV algorithm in acute care settings to standardize training and provide a bedside decision tool for clinicians; to minimize errors, optimize patient care, and enhance clinical outcomes.

Methods: A modified DELPHI process was used. Investigators created a stepwise MV algorithm and series of 7 DELPHI statements. The DELPHI panelists were identified and contacted through the Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) program platforms. Agreement was measured on a 5-point Likert scale. Consensus was defined as ≥70% of participants choosing “strongly agree” and “agree” on a particular statement collected via REDCap.

Results: A total of 50 participants from 19 countries and 4 continents (America, Europe, Asia, and others) completed the DELPHI survey to reach a consensus on 7 statements provided. The panelists consisted of intensivists (86%), respiratory therapists (10%) and nurse practitioners (4%) from specialties; Internal Medicine (38%), Anesthesiology (24%), Cardiology (4%), Pulmonology and Surgery each constituted 6%. The DELPHI statements (% agreement) included: managing abnormal vital signs, and or ventilator alarming (86%), ventilation discrepancy and high peak pressure (86%), plateau pressure (94%), prevention of ventilator induced lung injury (VILI) (90%) and oxygen toxicity (86%), ventilator asynchrony (82%), ventilation liberation (96%). The cumulative degree of agreement for all statements, was 89% by the end of only one round of DELPHI. Eighty percent of the participants agreed to add this algorithm as a bedside tool. The panelists from the DELPHI round were invited to a final virtual focus group meeting.

Conclusions: All the statements from our structured bedside MV algorithm reached an agreement above the consensus threshold. Prospective implementation and outcomes assessment are required to establish the clinical utility of our MV algorithm.