Use of Simulation to Train Non-Anesthesia Clinicians in the Use of Isoflurane for ICU Sedation

Introduction: Invasively ventilated patients in the intensive care unit (ICU) often need sedation. In the United States, this has traditionally been achieved with intravenous (IV) sedatives. In contrast, inhaled sedation has been safely and effectively used in Europe with the Sedaconda ACD (Anesthetic Conserving Device). This device allows volatile anesthetics to be administered through most mechanical ventilators, making it ideal for use in an ICU setting. Using this device in the ICU has shown several benefits of inhaled sedation, including ease of titration, rapid and predictable clearance independent of liver or kidney function, making awakening sedated patients both faster and safer. In this study, we evaluate the effectiveness of simulated-use training and knowledge-based testing in instructing various U.S. non-anesthesia healthcare professionals to use the Sedaconda ACD. The main goal was to complete specific critical and non-critical tasks related to the safe operation of the Sedaconda ACD for inhaled sedation.


Methods: A total of 60 participants representing the four intended user groups (Pharmacists, Prescribers, RNs, and RTs) were enrolled in the study. Participants were sent online educational material prior to attending two sessions: a training session conducted by a Super User and a one-on one testing session conducted by a study moderator. The study assessed all critical and non-critical tasks associated with the use of the Sedaconda ACD.


Results: The outcomes of the summative study showed a low task failure rate in all critical tasks related to the use of the ACD-S. There were a significant number of task failures concerning the use of the syringe. The existing data will be used in a residual risk analysis to determine whether additional risk management measures should be implemented.


Conclusions: A preliminary analysis of the associated risks indicated a need to modify the training for pharmacist user groups, which will be revalidated in a supplementary study. Overall, the results show promise for using simulated use training to teach providers how to use new inhaled anesthetic devices in ICU patients in the U.S.