Critical Care Residents Research Articles

Retrospective evaluation of a right heart parameter score in the assessment of precapillary pulmonary hypertension in dogs (2017-2021): 135 cases.

To determine if emergency and critical care residents can identify moderate to severe precapillary pulmonary hypertension on cardiologist-obtained cineloops using a pulmonary hypertension score (PHS) and report the interobserver variability of the PHS. Multicenter, retrospective, case-control study from 2017 to 2021. Private referral center and veterinary teaching hospital. One hundred and thirty-five client-owned dogs that underwent diagnostic echocardiography. None. Medical records of dogs with stage B1 myxomatous mitral valve disease (MMVD) and dogs diagnosed with precapillary pulmonary hypertension (PCPH) via echocardiograms were reviewed. Dogs were categorized by a cardiologist into 5 groups (normal, B1 MMVD, mild, moderate, and severe PCPH) based on Doppler pulmonary pressure gradients and right heart morphology. Cineloops from each case were subjectively evaluated by emergency and critical care residents for the presence of right atrial and ventricular enlargement, right ventricular hypertrophy, interventricular septal flattening, and pulmonary artery and trunk enlargement to form a composite pulmonary hypertension score out of 8 (PHS8). When available, signs of peritoneal effusion and distention of the caudal vena cava were subjectively assessed to generate a pulmonary hypertension score out of 10 (PHS10). There was excellent discrimination of moderate to severe PCPH versus grouped absent to mild PCPH using PHS8 (area under the receiver operator curve [AUC] [95% confidence interval, CI]=0.90 [0.84-0.95], P<0.0001) and PHS10 (AUC [95% CI]=0.89 [0.81-0.97], P<0.0001). PHS8≥3 was 64% sensitive and 98% specific for moderate to severe PCPH (positive likelihood ratio [LR+] 32, negative likelihood ration [LR-] 0.37). PHS10≥3.3 was 64% sensitive and 92% specific for moderate to severe PCPH (LR+ 8, LR- 0.39). Interobserver agreement was good to excellent (intraclass correlation coefficient [ICC]=0.74 [95% CI: 0.66-0.80], n=135). Residents identified moderate to severe PCPH in dogs using PHS on cineloops previously obtained by a cardiologist. The interrater agreement was good to excellent with limited training. Prospective studies to determine if residents can obtain diagnostic images for PHS are warranted.

Intraobserver and interobserver reliability of standardized capillary refill time in dogs is high following observer training.

To assess intraobserver and interobserver reliability of capillary refill time (CRT) measurement in dogs using a standardized technique after training. 20 dogs presented to the emergency room. Dogs presented to the emergency room were prospectively recruited. Using a timing device and standardized technique, CRT was measured at the oral mucosa of the inner lip. Measurements were performed by 2 emergency and critical care residents (observer 1 [Ob1] and observer 2 [Ob2]) and repeated 3 times by each observer for each dog. CRT values and signalment were recorded. Intraobserver and interobserver reliability were analyzed by calculation of the coefficient of variation (CV%), intraclass correlation coefficient (ICC), and minimal detectable difference. Reliability was considered high if CV% was lower than 10% and ICC was between 0.9 and 1. Median CRT for Ob1 was 1.22 seconds and for Ob2 was 1.19 seconds. Intraobserver reliability was high, evidenced by a median CV% of 6.2% (range, 1.0% to 18.6%) and 9.5% (range, 1.3% to 22.6%) and an ICC of 0.97 (95% CI, 0.94 to 0.99) and 0.95 (95% CI, 0.90 to 0.98) for Ob1 and Ob2, respectively. Between observers, the CV% was 4.4% (range, 0.8% to 17.5%) and the ICC was 0.98 (95% CI, 0.94 to 0.99), indicating high interobserver reliability. The minimal detectable differences for intraobserver and interobserver were 0.30 and 0.34 seconds, respectively. The reported high reliability of CRT despite its subjective nature enhances its usefulness in daily practice. However, further research on the validity of CRT is warranted.

Reliability of point-of-care ultrasound to evaluate fluid tolerance performed by critical care residents

BackgroundPatients with hypotension usually receive intravenous fluids, but only 50% will respond to fluid administration. We aimed to assess the intra and interobserver agreement to evaluate fluid tolerance through diverse ultrasonographic methods.MethodsWe prospectively included critically ill patients on mechanical ventilation. One trained intensivist and two intensive care residents obtained the left ventricular outflow tract velocity–time integral (VTI) variability, inferior vena cava (IVC) distensibility index, internal jugular vein (IJV) distensibility index, and each component of the venous excess ultrasound (VExUS) system. We obtained the intraclass correlation coefficient (ICC) and Gwet’s first-order agreement coefficient (AC1), as appropriate.ResultsWe included 32 patients. In-training observers were unable to assess the VTI-variability in two patients. The interobserver agreement was moderate to evaluate the IJV-distensibility index (AC1 0.54, CI 95% 0.29–0.80), fair to evaluate VTI-variability (AC1 0.39, CI 95% 0.12–0.66), and absent to evaluate the IVC-distensibility index (AC1 0.19, CI 95% − 0.07 to 0.44). To classify patients according to their VExUS grade, the intraobserver agreement was good, and the interobserver agreement was moderate (AC1 0.52, CI 95% 0.34–0.69).ConclusionsPoint-of-care ultrasound is frequently used to support decision-making in fluid management. However, we observed that the VTI variability and IVC-distensibility index might require further training of the ultrasound operators to be clinically useful. Our findings suggest that the IJV-distensibility index and the VExUS system have acceptable reproducibility among in-training observers.

Influence of the embedded participant on learners’ performance during high-fidelity simulation sessions in healthcare

BackgroundThe embedded participant (EP) plays a key role during a full scale/high-fidelity simulation (HFS) session. He/she is expected to guide the learner towards the achievement of the educational objectives of the scenario. However, his/her influence on learners’ performance stands undetermined and this effect remains briefly addressed in the literature. This study primarily aims to assess whether the EP could have an influence on the performance of the learner during a HFS scenario. The secondary aim was to establish an inventory of the EP practices in France.MethodsThis retrospective study was conducted in Lyon Claude Bernard University Health Simulation Centre (France). Anaesthesia and critical care residents in postgraduate years 1 to 5 who were scheduled for their HFS sessions during the 2016 to 2021 academic years were included. Two investigators independently evaluated the resident performance regarding both technical and non-technical skills from video recordings. In addition, a nationwide survey was sent out by email through the networks of the Francophone Healthcare Simulation Society (SoFraSimS, Société Francophone de Simulation en Santé) to collect information on EP practices in French-speaking Simulation centres.ResultsFrom a total of 344 HFS videos analysed, a cohort of 19 experienced EPs was identified. The EPs had an influence on the technical and non-technical performances of the learners. The 147 responses to the survey showed that predefined rules of EP good practice existed in only 36% of the simulation centres and 65% of respondents believed that specific EP training would be justified.ConclusionThe EP can exert an influence on the performance of the learners during HFS. For acting as an EP, a great variability of practices and a lack of training are reported by professionals working in simulation centres. These results suggest that more attention must be paid to EP training and attitudes during simulation, especially if summative simulations are extensively developed.

A Model for Residency Training: The Small Animal Emergency and Critical Care Residency Program at Purdue University.

Training residents in any specialty is a balancing act between ensuring high-quality education, making certain the resident meets the requirements set forth by the specialty college to achieve credentials and be eligible to take the board certification examination, and fulfilling clinical duties at that institution. For programs such as this one, residents are integral members of the clinical team, working primary emergency receiving shifts in order to allow the service to function; this leads to a need to identify and protect learning time for the residents. Those involved in the Purdue Small Animal Emergency and Critical Care residency program believe that in the chaos that is emergency and critical care, a firm timeline with attainable checkpoints is crucial to resident success. Such a timeline follows goal-setting theory and provides structure and guidance to candidates to navigate their 3-year program and ensure that they complete all requirements during the residency period. Candidates completing the Purdue program successfully finish their credentials, including at least one first author publication, and have at least one scientific presentation to improve their curriculum vitae. This article serves to present the structure and timelines used by the Purdue Small Animal Emergency and Critical Care program to organize its residency program as an example of a successful program.

Implementation of a multi‐organizational PGY2 educational pharmacy residency coalition

AbstractBackgroundFor postgraduate year two (PGY2) pharmacy residency programs, there are required topics in the American Society of Health‐System Pharmacists competency areas, goals, and objectives that are defined as either direct or non‐direct patient experiences. For critical care and emergency medicine pharmacy residencies, many of these topics overlap not only in subject matter but designation of direct or non‐direct patient experiences. In an attempt to introduce these topics at a higher level and with less redundancy per residency program, the PGY2 Educational Pharmacy Residency Coalition was developed.AimsLimited data evaluates the impact of a regional collaboration to provide PGY2 critical care and emergency medicine residents with topic discussions to meet residency graduation completion requirements. This coalition focused on pairing topics with institutions that have self‐reported designated excellence or high experience within a specific patient population subset, as well as determining the impact to the program and the residents.Materials and MethodsA total of eight programs were identified for participation based on a geographic region. An initial questionnaire was sent to the programs to determine which patient populations they identified as having strong exposure versus which they had limited. Based on these results, topics were distributed as live presentations amongst the collaborative. A baseline, interim, and final assessment survey was sent to evaluate foundational knowledge and disease state management of each topic area.ResultsBoth residency program directors/preceptors and residents reported an increase in foundational knowledge and disease state management for all presentations that were conducted through the coalition. Residency program director/preceptor respondents (n = 12) reported that 100% of the topics provided were sufficient to meet expectations for the completion of a non‐direct patient care topic for the PGY2 resident.ConcluisonThis article discusses the successful implementation, structure, goals, and outcomes of a PGY2 Educational Pharmacy Residency Coalition. It includes the strategies used for the development of topic areas and discusses the growth of the program to include residents, preceptors, and program directors. Learning from this collborative will help other programs adopt a similar program, avoid pitfalls, and apply lessons learned to their own program.

The Role of a Pharmacy Administration and Leadership Rotation within Postgraduate Year Two Critical Care Residency Training.

The job of a critical care pharmacy specialist has evolved to include quality improvement and administrative tasks. As such, the American Society of Health-System Pharmacists (ASHP) highlights specific goals and objectives to ensure post-graduate year two (PGY2) critical care residents are sufficiently trained to perform these tasks. The PGY2 critical care pharmacy residency leadership at the University of Kentucky sought to develop a four-week learning experience entitled, "Critical Care Administration / Medication Use Quality & Outcomes," as a unique rotation to capture these requirements and activities. The focus of this commentary is to serve as a guide for other residency programs to develop such a rotation, highlight resulting resident contributions to the department, describe perceived benefits of this rotation for residents, and highlight how this rotation impacted graduated residents' early years as practitioners. This learning experience is pivotal to providing a more balanced view of the entire medication use process and the healthcare ecosystem during a specialty residency. PGY2 critical care residents can gain valuable experiences away from the bedside that better prepare them for future tasks in addition to patient care that will be expected of them as clinical pharmacists.

Point of Care Ultrasound (POCUS) Utilization and Barriers by Senior Emergency Medicine and Critical Care Residents at Two Teaching Referral Hospitals, Addis Ababa, Ethiopia.

POCUS has become an integral part of the practice of emergency medicine. POCUS is a highly focused, limited, goal-directed exam with the expressed purpose of answering selected questions used at the bedside for critically ill patients who are not stable. We aimed to assess POCUS utilization and barriers by senior-year emergency medicine and critical care residents at two tertiary academic and referral hospitals in Addis Ababa, Ethiopia. Methodology. A cross-sectional study was conducted from June 1 to August 30, 2022 in St Paul's Hospital Millennium Medical College and Tikur Anbessa Specialized Hospital using an electronic survey of senior-year (second and third years) emergency medicine and critical care residents. Data were collected using Goggle form, exported to SPSS version 24, and then analyzed. Seventy-six residents out of 78 (97.4%) responded to the online survey. The mean age was 29.9 years with an SD of 2.87. Fifty-six residents (73.7%) were male and 45 (59.2%) were year 2 residents. Sixty-one (76.3%) had previous POCUS training. Fifty residents (82.0%) received training from the classroom. Twenty-seven residents (35.5%) rated their current level of knowledge as good for sterile transducer techniques, 28 (36.8%) rated fair for their knobology, and 27 (35.5%) rated very good for their transducer selection knowledge. Thirty-two (42.1%) rated very good about their ability to interpret IVC. 26 (34.2%) responded that they had good ability to interpret FAST/EFAST. Forty-nine (64.5%) residents claimed lack of an ultrasound machine followed by 33 (43.4%) lack of organized curriculum were the main barriers to POCUS utilization. Forty-two (55.3%) residents preferred to complete face-to-face teaching, while 33 (43.4%) preferred blended learning both face-to-face and online. POCUS is performed by the majority of EMCC residents. The most frequent scans performed by residents were FAST, IVC, and lung scans. Lack of ultrasound machine and organized curriculum was the main barrier to US utilization. Availability of equipment, face-to-face training, and having an organized curriculum are recommended by residents to improve their skills in the future.

A survey of critical care pharmacists on venous thromboembolism prophylaxis dosing practices with enoxaparin in adult trauma patients

AbstractEnoxaparin is the preferred treatment for venous thromboembolism (VTE) prophylaxis in trauma patients, but timing of initiation, optimal dosing, and therapeutic drug monitoring remain controversial. The objective of this study was to evaluate enoxaparin VTE prophylaxis practices in adult trauma patients across trauma centers in the United States and compare results to current guideline recommendations. An online survey designed by the study investigators was sent to pharmacist members of the American College of Clinical Pharmacy (ACCP) Critical Care Practice Research Network (PRN) and residency directors of institutions with accredited Critical Care Pharmacy Residency programs in the fall of 2021. This survey queried pharmacists' self‐reported practices regarding enoxaparin dosing and monitoring in trauma patients. One hundred five responses were collected with an estimated response rate of 5.3%. Most respondents reported using a standard enoxaparin dose of 30 mg subcutaneously (SUBQ) every 12 h (67%; 70/104) in trauma patients with normal renal function and higher initial dosing for obese trauma patients (75%; 78/104). The most common body mass index (BMI) threshold for dose adjustments in obesity was a BMI ≥40 kg/m2; whereas 100 kg or more was commonly reported for a weight threshold. Multiple alternative enoxaparin dosing regimens were reported for obese and overweight patients. Of respondents who monitor anti‐Factor Xa (anti‐Xa) levels, 84% (61/73) reported monitoring peak levels with 47% (29/61) targeting a peak anti‐Xa goal of 0.2–0.4 units/ml. Seventy‐five percent (51/68) of respondents who adjust enoxaparin dosing based on anti‐Xa level monitoring reported adjusting doses by increments of 10 mg SUBQ every 12 h, and 41% (28/68) indicated having a pharmacist‐driven protocol for dose adjustments. Significant variation exists in enoxaparin dosing and monitoring strategies for VTE prophylaxis. Consensus among clinical practice guidelines is needed to standardize practice nationally.

Publication rates and characteristics of PGY2 psychiatric pharmacy resident research projects.

To describe the publication rates and characteristics of PGY2 psychiatric pharmacy residency projects presented as a poster presentation at the annual meetings of the College of Psychiatric and Neurologic Pharmacists (CPNP) from 2002 to 2018. (As of 2022 the organization is under the name, American Association of Psychiatric Pharmacists.). CPNP abstracts from even years were strategically searched in PubMed, Ovid MEDLINE, and Google Scholar. If a publication was identified, additional data were collected for characterization, including study information, journal information, author information, institutional affiliation, publication year, and time to publication. A total of 348 abstracts were evaluated. Publication in a journal was achieved for 60 projects (17.2%), with publication rates decreasing from 2012 to 2018. The mean time to publication was 17.3 months after completion of the residency, with most projects published at 8 months. More than half (51.7%) of these projects were published in a psychiatric pharmacy journal affiliated with CPNP. Study designs were predominantly retrospective, observational, cohort studies with a focus on evaluation of a drug therapy outcome. The PGY2 resident was the first author in 90% of the publications. Forty percent included other health care professionals outside of pharmacy as a coauthor. PGY2 residencies affiliated with academic institutions had overall higher publications rates. Publication rates for PGY2 psychiatric pharmacy residency projects are low and are decreasing over time despite an increasing number of PGY2 psychiatric pharmacy residency programs. This publication rate is lower than that reported in the literature for PGY2 critical care residency programs. The downward trend of publication rates for PGY2 psychiatric pharmacy residency projects is concerning.

A study of prevalence of burnout among critical care residents at Alexandria main University HospitalAmr Abdalla Elsayed1

A study of prevalence of burnout among critical care residents at Alexandria main University HospitalAmr Abdalla Elsayed1

Point-of-care ultrasound training for residents in anaesthesia and critical care: results of a national survey comparing residents and training program directors’ perspectives

BackgroundPoint-of-care ultrasound (POCUS) has become an essential tool for anaesthesia and critical care physicians and dedicated training is mandatory. This survey describes the current state of Italian residency training programs through the comparison of residents’ and directors’ perspective.MethodsObservational prospective cross-sectional study: 12-question national e-survey sent to Italian directors of anaesthesia and critical care residency programs (N = 40) and residents (N = 3000). Questions focused on POCUS teaching (vascular access, transthoracic echocardiography, focused assessment for trauma, transcranial Doppler, regional anaesthesia, lung and diaphragm ultrasound), organization (dedicated hours, teaching tools, mentors), perceived adequacy/importance of the training and limiting factors.ResultsFive hundred seventy-one residents and 22 directors completed the survey. Bedside teaching (59.4–93.2%) and classroom lessons (29.7–54.4%) were the most frequent teaching tools. Directors reported higher participation in research projects (p < 0.05 for all techniques but focused assessment for trauma) and simulation (p < 0.05 for all techniques but transthoracic echocardiography). Use of online teaching was limited (< 10%); however, 87.4% of residents used additional web-based tools. Consultants were the most frequent mentors, with different perspectives between residents (72.0%) and directors (95.5%; p = 0.013). Residents reported self-training more frequently (48.5 vs. 9.1%; p < 0.001). Evaluation was mainly performed at the bedside; a certification was not available in most cases (< 10%). Most residents perceived POCUS techniques as extremely important. Residents underestimated the relevance given by directors to ultrasound skills in their evaluation and the minimal number of exams required to achieve basic competency. Overall, the training was considered adequate for vascular access only (62.2%). Directors mainly agreed on the need of ultrasound teaching improvement in all fields. Main limitations were the absence of a standardized curriculum for residents and limited mentors’ time/expertise for directors.ConclusionPOCUS education is present in Italian anaesthesia and critical care residency programs, although with potential for improvement. Significant discrepancies between residents’ and directors’ perspectives were identified.

An internet survey of the perceived prevalence of zoological companion animal (ZCA) species being evaluated by ACVECC diplomates and emergency and critical care residents and to gauge potential interest in advanced training opportunities in the emergency treatment of these patients.

To describe the perceived prevalence of zoological companion animal (ZCA) species being evaluated and treated by American College of Veterinary Emergency and Critical Care (ACVECC) diplomates and Emergency and Critical Care (ECC) residents in an emergency room (ER) setting and to assess potential interest in further training for the ACVECC community in the emergency treatment and stabilization of these species. Internet-based survey. One hundred and thirty-nine ACVECC diplomates and ECC residents. An online survey was designed and administered to assess the perceived prevalence of ZCA species that were evaluated and treated in the veterinary ER and to gauge potential interest in advanced training opportunities in the emergency treatment of these patients. One hundred and fifteen (83%) respondents reported that their hospital offered veterinary services to ZCA species during business hours and 120 (86%) reported that they offered veterinary services to ZCA species during off-hours. Ninety-one (65%) respondents reported that ZCA patients were evaluated and treated through their ER with small mammals (n=60/91 [66%]) and small birds (n=48/91 [53%]) being the most common species presented. In hospitals with an available ZCA specialist (80/139 [56%]), primary case responsibility was maintained by the ZCA specialist 24-7 in 11 of 91 (14%) hospitals. Seventy-three (53%) ACVECC diplomate and ECC resident survey respondents reported clinical training specific to ZCA species during veterinary school. A total of 84 of 139 (60%) survey respondents expressed interest in further training regarding ZCA species, with 73 of 84 (87%) those individuals specifying interest or potential interest in a formal ACVECC certificate or other type of advanced training.

Prevalence and risk factors for depressive symptoms in physicians working in the icus in alexandria main university hospital

Introduction Depression can lead to significant emotional distress or impairment in social life, home life, and work. Both depression and substance disorders have been identified as major risk factors for the high rate of suicides among physicians, with more than 90% of those physicians who suicide having a history of mood disorder and/or substance abuse. Therefore, interest in the psychological well-being of physicians has increased recently, warranting further research regarding factors that influence the mental health of physicians. Worldwide prevalence of depression among physicians is around 28.8% (20–40%). Both developing and developed countries were high in the prevalence of depression in physicians. The percentage was more marked in a study from Egypt (73.8%) and USA (41%). Fewer studies are found in Asian countries. But the rate was high eventually (30.1%). Objective The aim of the study was to estimate the prevalence of depressive symptoms among critical care residents in Alexandria Main University Hospital and to identify the risk factors among them. Patients and methods This study implemented a cross-sectional survey. We present a questionnaire to each doctor, which includes three sections: sociodemographic information, lifestyle- and work-related characteristics, and Patient Health Questionnaire-9 survey. Results Three quarter of the surveyed ICU physicians reported moderate to severe depressive symptoms. In women, the level of stress is significantly higher than in men. In people working in the 12 and 24-h system and taking overtime hours, the stress level was the highest. Poor patient outcome and decisions with do-not-resuscitate are contributing with more depressive symptoms. Physically active physicians have less depressive symptoms. Conclusion Prevalence of depressive symptoms was high among Alexandria Main University Hospital residents. Lack of support and large number of patients along with poor patient outcome and long working hours were the most relevant risk factors.

Implementation of a unique mass casualty and emergency preparedness longitudinal learning experience for postgraduate year 2 pharmacy residents

Background and purposeThe American Society of Health-System Pharmacists (ASHP) postgraduate year 2 (PGY2) critical care pharmacy residency program offers an elective competency area, E3: Mass Casualty. Similar elective competencies are also available for PGY2 emergency medicine and postgraduate year 1/2 pharmacotherapy programs. Because of the COVID-19 pandemic, pharmacist proficiency in the management of disasters is even more urgent. However, few residency programs require or include a specific learning experience to achieve this competency. This article provides examples of opportunities that residency programs can implement to offer an Emergency Preparedness/Mass Casualty (EP/MC) learning experience. Educational activity and settingA longitudinal EP/MC learning experience was integrated into a PGY2 critical care program. FindingsA longitudinal EP/MC learning experience within the PGY2 critical care, emergency medicine, and pharmacotherapy residency program curricula is achievable and promotes resident development. Learning experience components included topic discussions, participation on local and state-level emergency preparedness (EP) committees, completion of certification programs, projects, and participation on statewide emergency response teams. SummaryImplementation of a longitudinal EP/MC learning experience formalizes topics and activities that support achievement of the ASHP elective competency area of Mass Casualty for PGY2 residency programs. EP/MC goals and objectives should be a requirement for critical care, emergency medicine, pharmacotherapy, and health-system pharmacy administration and leadership PGY2 programs. By formalizing training, pharmacists can be better prepared for EP and more integrated into multidisciplinary disaster response teams.

Effects of relaxing breathing paired with cardiac biofeedback on performance and relaxation during critical simulated situations: a prospective randomized controlled trial

BackgroundActive participation in high-fidelity simulation remains stressful for residents. Increased stress levels elicited during such simulation impacts performance. We tested whether relaxing breathing, paired or not with cardiac biofeedback, could lead to enhanced performance of residents during simulation.MethodsThis randomized pilot study involved the fifth-year anesthesiology and critical care residents who participated in high-fidelity at Lyon medical simulation center in 2019. Residents were randomized into three parallel interventions: relaxing breathing, relaxing breathing paired with cardiac biofeedback, and control. Each intervention was applied for five minutes immediately after the scenario briefing. The primary endpoint was the overall performance during the simulation rated by two blinded independent investigators. The secondary endpoints included component scores of overall performance and changes in psychological states.ResultsThirty-four residents were included. Compared to the control group, residents in the relaxing breathing (+ 7%, 98.3% CI: 0.3 to 13.7, P = 0.013) and relaxing breathing paired with cardiac biofeedback (+ 8%, 98.3% CI: 0.82 to 14.81, P = 0.009) groups had a higher overall performance score. Following the interventions, compared to the control group, stress level was lower when participants had performed relaxing breathing alone (P = 0.029) or paired with biofeedback (P = 0.035). The internal relaxation level was higher in both the relaxing breathing alone (P = 0.016) and paired with biofeedback groups (P = 0.035).ConclusionsPerforming five minutes of relaxing breathing before the scenario resulted in better overall simulation performance. These preliminary findings suggest that short breathing interventions are effective in improving performance during simulation.Trial registrationThe study protocol was retrospectively registered on clinicaltrials.gov (NCT04141124, 28/10/2019).

The Impact of the COVID-19 Pandemic on the Intensive Care Residency Program in Portugal

In 2020, critical care departments underwent profound changes imposed by the COVID-19 pandemic. The aim of this study was to evaluate the impact of the pandemic on the intensive care residency program in Portugal. The Association of Critical Care Residents (AIMINT) prepared a questionnaire using the Google Forms® tool, which was applied during August 2020 to the Critical Care residents in Portugal. A descriptive analysis was performed with the data collected. Eighty-five residents participated in the questionnaire, yieldinga response rate of 62%. Three-quarters of all participants provided care to COVID-19 patients. More than 80% of the surveyed participants were on rotations, and these were canceled in 59% of cases. Seventy-eight percent reported a workload greater than 40 hours per week. The COVID-19 pandemic had an impact on the Critical Care Residency program in Portugal. Most residents surveyed provided care to COVID-19 patients and not only saw their rotations suspended but also experienced difficulties in rescheduling them.

Critical Care Pharmacy Program Accreditation Standards Framework and Core Competencies in Saudi Arabia

Clinical pharmacy services in Saudi Arabia are expanding steadily, particularly with notable developments in critical care pharmacy services and training programs, including four critical care residency programs localized in Riyadh and one program in Jeddah. The Scientific Council of Pharmacy leads extensive efforts to advance clinical pharmacy practice and training under the Saudi Commission for Health Specialties (SCFHS), the accrediting body for critical care training programs and all other specialties. Despite launching critical care pharmacy programs in 2013, currently available accreditation standards and competency assessments for specialized residency programs in critical care were established in 2020. These accreditation standards and competency assessment modalities have been found to have significant areas of improvement based on the feedback of practicing critical care pharmacy residency program directors and trainees over the past few years. This is an opinion paper based on a consensus of critical care and emergency medicine pharmacy experts which recommends updating the current accreditation standards framework and competency assessment blueprint for specialized critical care pharmacy programs. Additionally, it highlights the need to modify the accreditation standards framework for critical care pharmacy programs. Further evaluation of these modalities can be revised as deemed reasonable by governmental authorities by recruiting practicing critical care clinical pharmacy experts.

Acute Poisoning Cases Presented to the Addis Ababa Burn, Emergency, and Trauma Hospital Emergency Department, Addis Ababa, Ethiopia: A Cross-Sectional Study

Background Acute poisoning is a common reason for visits to the emergency room and hospitalization across the world, as well as a possible cause of morbidity and death. This study aimed to assess acute poisonings at Addis Ababa Burn, Emergency, and Trauma (AaBET) Hospital. Methodology. A one-year cross-sectional study was conducted at AaBET Hospital from February 1, 2018, to January 31, 2019. Data were collected using a structured and pretested questionnaire by the Emergency Medicine and Critical Care residents from acutely poisoned patients' interviews and patient charts. Results Data were collected from 98 acute poisoning cases, and 52% were males and 48% were females. 85 (86.7%) were less than 45 years. 52 (55.1%) were unemployed, and 33 (33.7%) were farmers. 96 (98%) cases were due to intentional poisoning, and 96 (98%) had oral ingestion. Organophosphates poisoning (27.5%) was the commonest cause, followed by 26.5% of unknown poisons and 16.3% prescribed drugs. Sixty-six percent of the patients presented to the hospital after 2 hours of ingestion. The case fatalities were 10.2% of which 40% of the cases were due to 2,4-dichlorophenoxyacetic (2, 4-D) poisoning, followed by aluminum phosphide (20%). Conclusion This study showed farmers and the unemployed were more affected. The most common mode of poisoning was intentional poisoning, oral ingestion being the primary route. The common poisons used by the victims were organophosphates. 2, 4-D poisoning was the major cause of death.

Abstract 13198: Impact of Targeted Resident Education on Perceptions of Communication and Participation in Cardiac Arrest

Introduction: Debriefing sessions after in-hospital cardiac arrest have been demonstrated to improve teamwork and survival outcomes. Though recommended in 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, implementation remains low. Hypothesis: We postulated that a didactic training session provided to code leaders would increase rates of participation of AHA-recommended post-arrest debriefing sessions. Methods: Surveys were distributed to hospital personnel who participate in code blue/ERTs at an academic, tertiary-care medical center. Questions were graded on Likert scale to assess provider-reported perceptions of teamwork, communication, and confidence in conducting and participating in Code Blues. Participants were stratified in groups depending on whether they had previously participated in debriefing sessions. Primary outcomes were quantified using a Likert-type scale ranging from 1 to 5. Surveys were compared to surveys from prior years to assess if the intervention of a code blue didactics lecture delivered to code leaders resulted in any change in overall participation rate in the debriefing protocol. Results: Among 181 participants (61% female), 32% were residents, 54% nurses, 1.7% respiratory therapists. Self-evaluated current knowledge of ACLS protocols was significantly higher in the debriefing group (p = 0.0098), while there were no differences in perceived communication (p=0.76), and confidence in leading (p = 0.2) and participating (p = 0.2). We did not find a statistically significant difference in debriefing participation rate after our intervention (57% pre vs 58% post intervention, p=0.8), even when stratified by hospital role: critical care nurses (50% vs 71%, p=0.3), non-ICU nurses (68% vs 57%, p=0.3) and residents (67% vs 50%, p=0.2). Conclusions: Our study demonstrated that participation in post-code debriefing sessions was associated with a statistically significant increase in knowledge of cardiac arrest protocols. A code blue didactics lecture did not result in a statistically significant increase in post-arrest debriefing participation. Further study to elucidate methods to enhance adoption of this crucial, guideline recommended practice is warranted.