Developing and Implementing Noninvasive Ventilator Training in Haiti during the COVID-19 Pandemic

Abstract

Background: Noninvasive ventilation (NIV) is an important component of respiratory therapy for a range of cardiopulmonary conditions. The World Health Organization recommends NIV use to decrease the use of intensive care unit resources and improve outcomes among patients with respiratory failure during periods of high patient capacity from coronavirus disease (COVID-19). However, healthcare providers in many low- and middle-income countries, including Haiti, do not have experience with NIV. We conducted NIV training and evaluation in Port-au-Prince, Haiti.

Objectives: To design and implement a multimodal NIV training program in Haiti that would improve confidence and knowledge of NIV use for respiratory failure.

Methods: In January 2021, we conducted a 3-day multimodal NIV training consisting of didactic sessions, team-based learning, and multistation simulation for 36 Haitian healthcare workers. The course included 5 didactic session and 10 problem-based and simulation sessions. All course material was independently created by the study team on the basis of Accreditation Council for Continuing Medical Education-approved content and review of available evidence. All participants completed pre- and post-training knowledge-based examinations and confidence surveys, which used a 5-point Likert scale.

Results: A total of 36 participants were included in the training and analysis, mean age was 39.94 years (standard deviation [SD] = 9.45), and participants had an average of 14.32 years (SD = 1.21) of clinical experience. Most trainees (75%, n = 27) were physicians. Other specialties included nursing (19%, n = 7), nurse anesthesia (3%, n = 1), and respiratory therapy (3%, n = 1). Fifty percent (n = 18) of participants stated they had previous experience with NIV. The majority of trainees (77%) had an increase in confidence survey score; the mean confidence survey score increased significantly after training from 2.75 (SD = 0.77) to 3.70 (SD = 0.85) (P < 0.05). The mean knowledge examination score increased by 39.63% (SD = 15.99%) after training, which was also significant (P < 0.001).

Conclusion: This multimodal NIV training, which included didactic, simulation, and team-based learning, was feasible and resulted in significant increases in trainee confidence and knowledge with NIV. This curriculum has the potential to provide NIV training to numerous low- and middle-income countries as they manage the ongoing COVID-19 pandemic and rising burden of noncommunicable disease. Further research is necessary to ensure the sustainability of these improvements and adaptability to other low- and middle-income settings.

Keywords: COVID-19; acute respiratory failure; global health; noncommunicable disease; noninvasive ventilation.

Figure 1.

Map of Haiti with the 10 administrative districts outlined and labels indicating the primary practice location of the 36 participants, representing 15 different medical centers. Reproduced by permission from Reference .

Figure 2.

Each line represents an individual trainee’s (n = 31) average confidence score among 12 tested items before and after training on a Likert scale, with 1 indicating low comfort and 5 indicating high comfort. The blue line represents the group average, and shading represents the 95% confidence interval. Time 0 = before training; Time 1 = after training.

Figure 3.

Each line represents one of 36 trainees who completed pre- and post-training knowledge assessments. The blue lines represent the average domain score, and shading represents the 95% confidence interval. There was a significant improvement (P < 0.001) for all domains after training. The panels correspond to the five knowledge domains tested and the composite knowledge examination score. Time 0 = before training; Time 1 = after training.