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Nieves Alonso, R.M. Méndez Hernández, F. Ramasco Rueda, A. Planas Roca" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J.M." "apellidos" => "Nieves Alonso" "email" => array:1 [ 0 => "jesusmna@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R.M." "apellidos" => "Méndez Hernández" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Ramasco Rueda" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Planas Roca" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Percepción del médico sobre las ayudas cognitivas para el manejo de la hipoxemia en anestesia y cuidados críticos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2700 "Ancho" => 2202 "Tamanyo" => 445535 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Checklist for the management of hypoxemia in the operating theatre / Intensive Care Unit.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cognitive aids (CA) are defined as tools designed to guide the performance of a task or group of tasks in order to reduce errors or omissions and increase the speed and effectiveness of diagnosis and treatment.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In recent years, the complexity of anaesthesia and intensive care treatment has increased exponentially. In this context, CAs can facilitate work in these complex environments.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There is extensive literature on a wide range of cognitive aids, such as checklists, algorithms, mnemonic rules, in multiple formats, such as pocket cards, mobile phone applications or posters. However, their use in the management of critical situations is neither widespread nor universally accepted.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We believe it is necessary to poll anaesthetists and intensive care specialists on CAs in order to understand the causes of the apparent “resistance” to their standardised use in critical situations.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a survey using a two part questionnaire, administered before and after a clinical simulation scenario. The aim of the survey was to ascertain the level of acceptance of CAs among anaesthetists and intensive care specialists, and to determine whether their opinion on the effectiveness of these tools changes after using them in a clinical simulation context. The survey was carried out as part of an annual mechanical ventilation training course; an international event for anaesthetists and intensive care specialists.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 261 participants were given a mixed semi-structured questionnaire divided into two parts. The questionnaire was completed voluntarily and anonymously. The first part of the questionnaire contained closed questions designed to reveal the opinion of professionals on CAs in hypoxemic patients.</p><p id="par0030" class="elsevierStylePara elsevierViewall">After completing the first part of the questionnaire, participants received a theoretical-practical workshop on the physiology of oxygenation, which included a clinical simulation involving the management of a patient presenting severe hypoxaemia in the intensive care unit.</p><p id="par0035" class="elsevierStylePara elsevierViewall">After the scenario, during the debriefing, participants were shown a checklist for the differential diagnosis of hypoxemia in the operating theatre and ICU, which was available on request, but not clearly on display during the clinical simulation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). This hypoxemia checklist was developed by the authors, based on earlier publications by David Gaba and F. Bressan. The CA was presented in checklist format, adapted for use in both critical care and intraoperative anaesthesia.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This CA has not been previously validated for the management of hypoxaemia; however, our objective was not to determine its effectiveness in the management of a hypoxemic crisis, but to ascertain the physician’s opinion on its potential usefulness (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">After the debriefing, all participants repeated the simulation scenario, but this time using the checklist as a cognitive aid. Immediately after the debriefing, which included a review of the checklist, the participants completed the second part of the questionnaire, where they were asked to rate the usefulness of the checklist and the clinical simulation as a training tool in similar situation from 1 to 10 (1 = totally disagree, 10 = totally agree) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The results showed that only 22.9 % (60/261) of respondents regularly used CAs for hypoxaemia management in the operating room or medical/surgical intensive care unit (ICU). When asked why physicians do not usually use CAs during a hypoxaemic crisis, 88.89 % (232/261) of respondents replied that the main reason is that they are not readily available, a further 6.51 % (17/261) said they are difficult to use; 3.45 % (9/261) believed that they are unnecessary, and 1.15 % (3/261) were of the opinion that using a CA would make them a “bad physician”.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Based on the simulation scenario, 9.3/10 (SD: 1.05) participants considered the checklist to be a useful tool in the management of hypoxaemia; 9.1 (SD: 1.05) found it user-friendly, and 9.2/10 (SD: 1.08) intended to make regular use of the checklist, if it was available in their preferred format. Nearly all participants (9.3/10 [SD: 1.23]) found simulation-based training in the management of this type of cognitive aid to be useful.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The results of our survey suggest that the majority of anaesthetists and intensive care specialists deal with critical situations without using cognitive aids if they have not been previously trained in their use.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Most of our participants thought that lack of availability is the main barrier preventing them from using cognitive aids in clinic and emergency situations. However, there are a great number of cognitive aids available in a wide range of formats and presentations.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Once they had become familiar with the hypoxaemia checklist, participants expressed a positive attitude toward this type of CA. They considered them useful and easy to use, and firmly intended to use them in their daily practice if they were available in their preferred format.</p><p id="par0070" class="elsevierStylePara elsevierViewall">CAs are rarely used in routine clinical practice. Only a minority of clinical specialists use them when they are available.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In this context, we find clinical simulation to be a useful learning and training tool for raising awareness of the usefulness of CA during medical emergencies. Therefore, simulation contributes towards promoting a safety culture.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Our study has several limitations. First, we used an original questionnaire and a CA (checklist) that had not been validated. Second, there are several cognitive aids available in the literature; however, we chose this one because we consider it to be better suited for our main objective. Third, the second part of the survey was conducted immediately after the simulation; most participants only witnessed the scenario, and their involvement and feedback was limited to the debriefing. All these factors limit the external validity of our results.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In conclusion, the mains reasons for the limited acceptance of CAs in anaesthesia and intensive care are ignorance of their existence, and lack of familiarity with their use. Clinical simulation may be a useful tool to change physician´s attitude and encourage the future use of CAs in the management of patients during critical situations in anaesthesia and intensive care. Further studies are needed to test this hypothesis.</p><span id="sec5040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect6100">Declaration of Competing Interest</span><p id="par3180" class="elsevierStylePara elsevierViewall">The authors declare that they have no knowncompeting financial interests or personalrelationships that could have appeared to influence the workreported in this paper.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec5040" "titulo" => "Declaration of Competing Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Nieves Alonso JM, Méndez Hernández RM, Ramasco Rueda F, Planas Roca A. Percepción del médico sobre las ayudas cognitivas para el manejo de la hipoxemia en anestesia y cuidados críticos. Rev Esp Anestesiol Reanim. 2019;66:558–561.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2700 "Ancho" => 2202 "Tamanyo" => 445535 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Checklist for the management of hypoxemia in the operating theatre / Intensive Care Unit.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3265 "Ancho" => 2231 "Tamanyo" => 384141 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2345 "Ancho" => 2458 "Tamanyo" => 331169 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cognitive aids in process environments: prostheses or tools?" 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Journal Information
Vol. 66. Issue 10.
Pages 558-561 (December 2019)
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Vol. 66. Issue 10.
Pages 558-561 (December 2019)
Letter to the Director
Physician’s perception of cognitive aids for hypoxemia management in anesthesia and critical care
Percepción del médico sobre las ayudas cognitivas para el manejo de la hipoxemia en anestesia y cuidados críticos
Visits
5
J.M. Nieves Alonso
, R.M. Méndez Hernández, F. Ramasco Rueda, A. Planas Roca
Corresponding author
Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain
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