title: A Critical Review of Mechanical Ventilation Virtual Simulators: Is It Time to Use Them?
abstract: BACKGROUND
  Teaching mechanical ventilation at the bedside with real patients is difficult with many logistic limitations. Mechanical ventilators virtual simulators (MVVS) may have the potential to facilitate mechanical ventilation (MV) training by allowing Web-based virtual simulation.
  
  
  OBJECTIVE
  We aimed to identify and describe the current available MVVS, to compare the usability of their interfaces as a teaching tool and to review the literature on validation studies.
  
  
  METHODS
  We performed a comparative evaluation of the MVVS, based on a literature/Web review followed by usability tests according to heuristic principles evaluation of their interfaces as performed by professional experts on MV.
  
  
  RESULTS
  Eight MVVS were identified. They showed marked heterogeneity, mainly regarding virtual patient's anthropomorphic parameters, pulmonary gas exchange, respiratory mechanics and muscle effort configurations, ventilator terminology, basic ventilatory modes, settings alarms, monitoring parameters, and design. The Hamilton G5 and the Xlung covered a broader number of parameters, tools, and have easier Web-based access. Except for the Xlung, none of the simulators displayed monitoring of arterial blood gases and alternatives to load and save the simulation. The Xlung obtained the greater scores on heuristic principles assessments and the greater score of easiness of use, being the preferred MVVS for teaching purposes. No strong scientific evidence on the use and validation of the current MVVS was found.
  
  
  CONCLUSIONS
  There are only a few MVVS currently available. Among them, the Xlung showed a better usability interface. Validation tests and development of new or improvement of the current MVVS are needed.
authors.affiliation: Federal University of Ceara, Medicine, Federal University of Ceara, Fortaleza, Brazil. juarcanjolino@hotmail.com.
authors.forename: Juliana Arcanjo
authors.identifier: http://orcid.org/0000-0003-0968-4800
authors.initials: JA
authors.lastname: Lino
authors.forename: Gabriela Carvalho
authors.identifier: http://orcid.org/0000-0002-9342-7737
authors.initials: GC
authors.lastname: Gomes
authors.forename: Nancy Delma Silva Vega Canjura
authors.identifier: http://orcid.org/0000-0001-9353-2150
authors.initials: ND
authors.lastname: Sousa
authors.forename: Andrea K
authors.identifier: http://orcid.org/0000-0002-4464-3329
authors.initials: AK
authors.lastname: Carvalho
authors.forename: Marcelo Emanoel Bezerra
authors.identifier: http://orcid.org/0000-0002-5501-451X
authors.initials: ME
authors.lastname: Diniz
authors.forename: Antonio Brazil
authors.identifier: http://orcid.org/0000-0001-6608-3134
authors.initials: AB
authors.lastname: Viana Junior
authors.forename: Marcelo Alcantara
authors.identifier: http://orcid.org/0000-0002-6002-0084
authors.initials: MA
authors.lastname: Holanda
keywords: computer simulation; learning; medical education; positive-pressure respiration