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High-Fidelity Simulation Nurse Training Reduces Unplanned Interruption of Continuous Renal Replacement Therapy Sessions in Critically Ill Patients: The SimHeR Randomized Controlled Trial

Lemarie, Pierre MD*; Husser Vidal, Solenne MD*; Gergaud, Soizic MD*,†; Verger, Xavier BSN*; Rineau, Emmanuel MD*,†; Berton, Jerome MD*,†; Parot-Schinkel, Elsa MD; Hamel, Jean-François MD, PhD; Lasocki, Sigismond MD, PhD*,†

doi: 10.1213/ANE.0000000000003581
Critical Care and Resuscitation: Original Clinical Research Report

BACKGROUND: Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions (UI) often limit its usefulness. In many units, nurses are responsible for CRRT management. We hypothesized that a nurse training program based on high-fidelity simulation would reduce the rate of interrupted sessions.

METHODS: We performed a 2-phase (training and evaluation), randomized, single-center, open study: During the training phase, intensive care unit nurses underwent a 6-hour training program and were randomized to receive (intervention) or not (control) an additional high-fidelity simulation training (6 hours). During the evaluation phase, management of CRRT sessions was randomized to either intervention or control nurses. Sessions were defined as UI if they were interrupted and the interruption was not prescribed in writing more than 3 hours before.

RESULTS: Study nurses had experience with hemodialysis, but no experience with CRRT before training. Intervention nurses had higher scores than control nurses on the knowledge tests (grade, median [Q1–Q3], 14 [10.5–15] vs 11 [10–12]/20; P = .044). During a 13-month period, 106 sessions were randomized (n = 53/group) among 50 patients (mean age 70 ± 13 years, mean simplified acute physiology II score 69 [54–96]). Twenty-one sessions were not analyzed (4 were not performed and 17 patients died during sessions). Among the 42 intervention and 43 control sessions analyzed, 25 (59%) and 38 (88%) were labeled as UI (relative risk [95% CI], 0.67 [0.51–0.88]; P = .002). Intervention nurses required help significantly less frequently (0 [0–1] vs 3 [1–4] times/session; P < .0001). The 2 factors associated with UI in multilevel mixed-effects logistic regression were Sequential Organ Failure Assessment score (odds ratio [95% CI], 0.81 [0.65–99]; P = .047) and the intervention group (odds ratio, 0.19 [0.05–0.73]; P = .015).

CONCLUSIONS: High-fidelity simulation nurse training reduced the rate of UI of CRRT sessions and the need for nurses to request assistance. This intervention may be particularly useful in the context of frequent nursing staff turnover.

From the *Département d’Anesthésie-Réanimation, L’UBL, Université d’Angers, CHU d’Angers, Angers, France

L’UBL, Université d’Angers, All’Sims (Angers Loire Learning Simulation en Santé), Angers, France

L’UBL, Université d’Angers, Maison de la Recherche, CHU d’Angers, Angers, France.

Published ahead of print 8 May 2018.

Accepted for publication May 8, 2018.

Funding: This study was funded solely by the CHU Angers. FRESENIUS Medical Care gave a MultiFiltrate hemofiltration machine for the CRRT simulator for free but was not involved in any aspect of the study.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Trial registration: NCT02379234.

P. Lemarie and S. Husser Vidal contributed equally and share first authorship.

Reprints will not be available from the authors.

Address correspondence to Sigismond Lasocki, MD, PhD, Département Anesthésie-Réanimation, CHU Angers, 4 rue Larrey, 49933 Angers Cedex 9, France. Address e-mail to

Copyright © 2018 International Anesthesia Research Society
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