Critical Care Medicine — Core of Discipline

C1 Managing patients with respiratory failure

Key Features:
- This EPA focuses on applying knowledge of respiratory physiology and pathophysiology for different modes of ventilation, while considering the interactions with other organ systems (e.g., cardiac and neurologic).
- This EPA includes assessment, diagnosis and management of hypoxemia, hypercarbia and mixed respiratory failure, including patients requiring mechanical ventilation to support other organ failure, and patients with complex respiratory failure including severe acute respiratory distress syndrome (ARDS).
- This EPA includes recognizing and managing complications from mechanical ventilation, as well as weaning patients from ventilation, and identifying candidates for tracheostomy.
- This EPA does not include airway management except the management of tracheostomies. It does not include routine indications for mechanical ventilation (i.e., postop facial surgery), nor does it include the chronic technology dependent patient.

Assessment Plan:
Direct observation and/or case discussion by a supervisor
Use Form 1. Form collects information on:
- ARDS: yes; no
Collect 8 observations of achievement
- At least 3 patients with ARDS
- At least 4 different observers

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of respiratory physiology and cardiopulmonary interactions

• ME 1.6. Adapt care to address complexity in the patient situation

• ME 1.4. Perform focused clinical assessments that address all relevant issues

• ME 2.2. Integrate information from the clinical assessment to formulate an understanding of the patient’s condition

• ME 2.2. Interpret diagnostic imaging of the respiratory system

• ME 2.4. Develop and implement management plans for patients requiring non-invasive or invasive ventilation, including weaning from prolonged and/or complicated mechanical ventilation

• ME 3.1. Determine the need for and timing of tracheostomy

• COM 1.3. Communicate effectively with other physicians and health professionals

• S 3.4. Integrate best evidence and clinical expertise into decision-making

Context Variables

• ARDS (single-choice)
  • No
  • Yes

Requirements

• Collect 8 observations of achievement (minimum 8)
• At least 3 patients with ARDS (minimum 3)
  • Only counts when ARDS is Yes
• At least 4 different observers (minimum 4)
  • Counted once per distinct Assessor