The Complexities of Mechanical Ventilation: Toppling the Tower of Babel

Abstract

The exponential increase in the complexity of ventilator technology has created a growing knowledge gap that hinders education, research, and ultimately the quality of patient care. This gap is best addressed with a standardized approach to educating clinicians, just as education for basic and advanced life support classes is standardized. We have developed such a program, called Standardized Education for Ventilatory Assistance (SEVA), based on a formal taxonomy for modes of mechanical ventilation. The SEVA program is a progressive system of 6 sequential courses starting from an assumption of no prior knowledge and proceeding to full mastery of advanced techniques. The vision of the program is to provide a unique platform for standardizing training by unifying the concepts of physics, physiology, and technology of mechanical ventilation. The mission is to use both online and in-person simulation-based instruction that has both self-directed and instructor-led components to elevate the skills of health care providers to the mastery level. The first 3 levels of SEVA are free and open to the public. We are developing mechanisms to offer the other levels. Spinoffs of the SEVA program include a free smartphone app that classifies virtually all modes on all ventilators used in the United States (Ventilator Mode Map), a free biweekly online training sessions focusing on waveform interpretation (SEVA-VentRounds), and modifications to the electronic health care record system for entering and charting ventilator orders.