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High-quality cardiopulmonary resuscitation is critical for patient survival, and its effectiveness depends on compression quality, team coordination, and leadership. The CPR coach provides real-time feedback aimed at optimizing chest compressions and enhancing the overall resuscitation process. The primary aim is to evaluate whether the presence and the position of a CPR coach are equivalent compared to the absence of a CPR coach regarding the team leader's performance. As a secondary objective, it was investigated whether the presence and the position of the CPR coach influence the teams' performance. This is single-center, randomized, controlled, three-arm, simulation-based equivalence trial. Teams of residents participated in standardized asystole scenarios, randomized to one of three groups: Group A (CPR coach positioned near the defibrillator), Group B (CPR coach allowed to move freely), and Group C (no CPR coach). The primary outcome was assessed using the Resuscitation Team Leader Evaluation Scale. The secondary outcome was measured by the Clinical Performance Tool and a CPR execution quality score derived from simulation manikin feedback. A total of 42 teams were included in the analysis. With respect to the primary outcome, team leader performance was statistically equivalent across Groups A, B, and C. As for the secondary outcome, no significant differences were observed in overall team performance. The presence and position of a CPR coach did not significantly influence team leader or team performance. Further research is needed to explore the role of CPR coaches in real-life settings and among more experienced teams. Trial registration: NCT05309434. Registered 15/04/2022.

Background Standard high-flow nasal cannula (HFNC) is a respiratory support device widely used to manage post-extubation hypoxemic acute respiratory failure (hARF) due to greater comfort, oxygenation, alveolar recruitment, humidification, and reduction of dead space, as compared to conventional oxygen therapy. On the contrary, the effects of the new asymmetrical HFNC interface (Optiflow® Duet system (Fisher & Paykel, Healthcare, Auckland, New Zealand) is still under discussion. Our aim is investigating whether the use of asymmetrical HFNC interface presents any relevant difference, compared with the standard configuration, on lung aeration (as assessed by end-expiratory lung impedance (EELI) measured by electrical impedance tomography (EIT)), diaphragm ultrasound thickening fraction (TFdi) and excursion (DE), ventilatory efficiency (estimated by corrected minute ventilation (MV)), gas exchange, dyspnea, and comfort. Methods Pilot physiological crossover randomized controlled study enrolling 20 adults admitted to the Intensive Care unit, invasively ventilated for at least 24 h, and developing post-extubation hARF, i.e., PaO 2 /set FiO 2  < 300 mmHg during Venturi mask (VM) within 120 min after extubation. Each HFNC configuration was applied in a randomized 60 min sequence at a flow rate of 60 L/min. Results Global EELI, TFdi, DE, ventilatory efficiency, gas exchange and dyspnea were not significantly different, while comfort was greater during asymmetrical HFNC support, as compared to standard interface (10 [7–10] and 8 [7–9], p-value 0.044). Conclusions In post-extubation hARF, the use of the asymmetrical HFNC, as compared to standard HFNC interface, slightly improved patient comfort without affecting lung aeration, diaphragm activity, ventilatory efficiency, dyspnea and gas exchange. Clinical trial number ClinicalTrial.gov. Registration number: NCT05838326 (01/05/2023). New & noteworthy The asymmetrical high-flow nasal cannula oxygen therapy (Optiflow® Duet system (Fisher & Paykel, Healthcare, Auckland, New Zealand) provides greater comfort as compared to standard interface; while their performance in term of lung aeration, diaphragm activity, ventilatory efficiency, dyspnea, and gas exchange is similar.

Mechanical ventilation is a fundamental intervention in intensive care medicine, providing vital support for patients with severe respiratory failure. However, this life-sustaining therapy also carries the risk of harm. Ventilator-induced lung injury (VILI) is now predominantly understood in terms of lung overdistension, characterized by excessive stress and strain on pulmonary tissue. In recent years, a variety of novel monitoring strategies have emerged, from refined measurements of respiratory mechanics to advanced imaging and physiologic modeling, to help in bedside detection of excessive lung stress and strain. Electrical impedance tomography is a non-invasive tool providing real-time imaging of regional ventilation and assisting in the diagnosis of overdistension and its minimization through positive end-expiratory pressure titration, also during partial support ventilation. Pleural and lung ultrasound might also suggest the occurrence of overdistension, although clinical data are still preliminary. Bedside maneuvers, such as changing patient positioning or applying abdominal weights, can help identify overdistension by observing change in respiratory mechanics. Ventilator-based methods like the recruitment-to-inflation ratio and the overdistension index help assess the risk of overdistension, despite requiring careful interpretation and validation. Biomarkers such as Clara cell secretory protein-16 and stretch-induced gene signatures represent a promising avenue for real-time monitoring of lung injury, though further validation is needed. These tools aim to help clinicians individualize ventilator settings, balancing adequate gas exchange with lung protection. Despite this progress, most techniques remain in the realm of research. Few have undergone the rigorous physiological and clinical validation necessary for routine bedside use. As the critical care community moves toward more personalized ventilation strategies, establishing reliable, real-time methods to assess lung stress and strain at the bedside will be key to translating innovation into improved patient outcomes.

Some experts have suggested how to use simulation during the pandemic, and simulation activities were carried out observing COVID-19 restrictions to improve technical and non-technical skills in health professionals. Several papers have been published on this. Through a retrospective review of the literature, we analyzed studies published during the pandemic to assess how simulation was used during this historical period. We conducted a retrospective review of the literature. The search generated 11,375 records. After removing duplicates, 5431 studies were screened. Of the 643 eligible full-texts, 221 were excluded. A total of 422 articles met the inclusion criteria. Half of the 422 included studies were carried out specifically for COVID-19 (211), while 152 (36%) were carried out during the pandemic but for other reasons. The analysis showed that simulation was used during the pandemic, with clear educational and research objectives. Most of the included studies dealt with COVID-19, focusing on high-acuity and critical scenarios but also including technical and non-technical skills. The experience gained from both “COVID-related” and “During COVID” studies could be applied to other settings in the event of urgent training needed for disasters and to tailor simulation courses for retaining technical skills.

Basic life support (BLS) is crucial in the emergency response system, as sudden cardiac arrest is still a major cause of death worldwide. Unfortunately, only a minority of victims receive cardiopulmonary resuscitation (CPR) from bystanders. In this context, training could be helpful to save more lives, and technology-enhanced BLS simulation is one possible solution. The aim of this study is to assess the feasibility and acceptability of our augmented reality (AR) prototype as a tool for BLS training. Holo-BLSD is an AR self-instruction training system, in which a standard CPR manikin is \"augmented\" with an interactive virtual environment that reproduces realistic scenarios. Learners can use natural gestures, body movements, and spoken commands to perform their tasks, with virtual 3D objects anchored to the manikin and the environment. During the experience, users were trained to use the device while being guided through an emergency simulation and, at the end, were asked to complete a survey to assess the feasibility and acceptability of the proposed tool (5-point Likert scale; 1=Strongly Disagree, 5=Strongly Agree). The system was rated easy to use (mean 4.00, SD 0.94), and the trainees stated that most people would learn to use it very quickly (mean 4.00, SD 0.89). Voice (mean 4.48, SD 0.87), gaze (mean 4.12, SD 0.97), and gesture interaction (mean 3.84, SD 1.14) were judged positively, although some hand gesture recognition errors reduced the feeling of having the right level of control over the system (mean 3.40, SD 1.04). We found the Holo-BLSD system to be a feasible and acceptable tool for AR BLS training.

The objective of this work was to provide pilot data on feasibility of using virtual reality (VR) to train undergraduate students in pediatric emergency scenarios. We staged VR sessions for a total of 45 medical and nursing students; in every session, each student managed two pediatric emergency virtual scenarios. At the end of the sessions, students completed a Technology Assessment Questionnaire to evaluate the perceived usefulness and perceived ease-of-use of their VR training experience and rated their perceived level of competence in managing the two clinical scenarios. The median perceived usefulness was 91.7/100 (interquartile range (IQR) 80.6–100), while the median perceived ease-of-use was 77.8/100 (IQR 63.9–88.9). The perceived level of competence increased from 2 (IQR 1–3) to 4 (IQR 3–4) on a 5-point Likert scale, for both scenarios ( p  < 0.001, Wilcoxon test for paired samples).        Conclusions : The staged VR sessions had a good perceived usefulness and resulted in an increase in the perceived level of competence. The results on the ease-of-use, however, show that an assumption that millennials and younger students can navigate with confidence VR hardware in a healthcare training setting should not be made; further work is required to ease the integration of VR into curricula. What is Known: • Virtual reality (VR) is a rising simulation training methodology in Pediatric Emergency Medicine (PEM), however little experience is reported about its use for undergraduate students What is New: • VR PEM trainiing was found useful by undergraduate students and its use increased their perceived level of competence, although ease-of-use received lower ratings. • Despite the young age, an assumption that millennials and younger students can navigate with confidence VR hardware in a healthcare training setting should not be made

Background The use of inhaled antibiotics for treating pneumonia in invasively ventilated patients offers a direct approach, allowing for high local concentrations of the drug in the lower respiratory tract while simultaneously reducing systemic toxicity. However, the real efficacy and safety of nebulized antibiotics remain unclear. The aim of the present is to assess among critically adult patients with pneumonia and invasive ventilation, whether receiving adjuvant inhaled antibiotics improves the rate of microbiological eradication. Methods A comprehensive literature search of randomized clinical trials (RCTs) was conducted (from inception until September 20, 2024, PROSPERO-CRD592906) across Medline, Embase, and Scopus. Randomized controlled trials, enrolling intensive care units (ICU) patients with pneumonia and comparing nebulized antimicrobial therapy (inhaled group) with intravenous antimicrobial treatment or intravenous antimicrobial therapy plus inhaled placebo (control group), were included. The primary outcome was the rate of microbiological eradication after treatment. Secondary outcomes were the rate of clinical recovery, the incidence of drug-related adverse events, ICU and hospital mortality. A qualitative analysis was conducted according to the GRADE framework. Data were pooled using an odds-ratio analysis. The heterogeneity and reliability of our results were evaluated using the I 2 -statistic and trial sequential analysis (TSA), respectively. Results A total of 11 RCTs (1472 patients) met the inclusion criteria. Compared to controls, the use of adjuvant inhaled antibiotics determined a greater rate of microbiological eradication (OR 2.63, 95% CI 1.36–5.09; low certainty of evidence). The TSA confirmed the reliability of our primary outcome. Moreover, nebulized antibiotics increased the risk of bronchospasm (OR 3.15, 95% CI 1.33–7.47; high evidence), while nephrotoxicity, clinical recovery, ICU and hospital survival (either in the case of pneumonia caused by MDR bacteria or not) were not different between groups. Conclusions In conclusion, compared to the sole intravenous therapy, the use of adjuvant inhaled antibiotics for treatment of pneumonia in invasively ventilated critically ill patients was associated with a greater incidence of microbiological eradication (low GRADE and high risk of publication bias), but not with clinical recovery and survival.