title: The effect of experience, simulator-training and biometric feedback on manual ventilation technique.
abstract: OBJECTIVE
  To determine the frequency of provision and main providers (veterinary surgeons, nurses or trainees) of manual ventilation in UK veterinary practices. Furthermore, to determine the variation in peak inspiratory (inflation) pressure (PIP), applied to a lung model during manual ventilation, by three different groups of operators (inexperienced, experienced and specialist), before and after training.
  
  
  METHODS
  Questionnaire survey, lung model simulator development and prospective testing.
  
  
  METHODS
  Postal questionnaires were sent to 100 randomly selected veterinary practices. The lung model simulator was manually ventilated in a staged process over 3 weeks, with and without real-time biometric feedback (PIP display), by three groups of volunteer operators: inexperienced, experienced and specialist.
  
  
  RESULTS
  The questionnaires determined that veterinary nurses were responsible for providing the majority of manual ventilation in veterinary practices, mainly drawing on theoretical knowledge rather than any specific training. Thoracic surgery and apnoea were the main reasons for provision of manual ventilation. Specialists performed well when manually ventilating the lung model, regardless of feedback training. Both inexperienced and experienced operators showed significant improvement in technique when using the feedback training tool: variation in PIP decreased significantly until operators provided manual ventilation at PIPs within the defined optimum range. Preferences for different forms of feedback (graphical, numerical or scale display), revealed that the operators' choice was not always the method which gave least variation in PIP.
  
  
  CONCLUSIONS
  This study highlighted a need for training in manual ventilation at an early stage in veterinary and veterinary nursing careers and demonstrated how feedback is important in the process of experiential learning. A manometer device which can provide immediate feedback during training, or indeed in a real clinical setting, should improve patient safety.
authors.affiliation: School of Veterinary Medicine, University of Surrey, Surrey, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lewis
authors.affiliation: Foxcotte Veterinary Group, Charlton, Hampshire, UK.
authors.forename: Cerrie A
authors.initials: CA
authors.lastname: Sherfield
authors.affiliation: School of Veterinary Medicine, University of Surrey, Surrey, UK.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Fellows
authors.affiliation: School of Veterinary Science, University of Liverpool, Liverpool, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Burrow
authors.affiliation: Institute of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Young
authors.affiliation: School of Veterinary Science, University of Liverpool, Liverpool, UK. Electronic address: alexdugdale@btinternet.com.
authors.forename: Alex
authors.initials: A
authors.lastname: Dugdale
mesh_terms: D000818:Animals; D001049:Apnea / Q000628:therapy / Q000662:veterinary; D001699:Biometry; D005246:Feedback; D019538:Health Care Surveys; D001239:Inhalation; D008168:Lung; D008953:Models, Anatomic; D009726:Nurses; D011312:Pressure; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods / Q000662:veterinary*; D000066908:Simulation Training; D019616:Thoracic Surgical Procedures / Q000662:veterinary; D018634:Veterinarians
keywords: IPPV; bagging; manometer; manual ventilation; simulation