Efeito da prática deliberada em ciclos rápidos na performance técnica da equipe multiprofissional no manejo da ventilação mecânica

Abstract

Introduction: Mechanical ventilation is widely used in the care of critically ill patients; however, it is associated with preventable complications such as Ventilator-Associated Pneumonia (VAP). Adherence to preventive measures depends on the technical performance of the multidisciplinary team, which is still characterized by variability in clinical practice. In this context, Rapid Cycle Deliberate Practice (RCDP) has emerged as an educational strategy based on structured task repetition and immediate feedback. Objective: To analyze the effect of simulation-based training using Rapid Cycle Deliberate Practice on the knowledge and technical performance of a multidisciplinary team in the management of mechanically ventilated patients. Methods: A multimethod study composed of a scoping review and a quasi experimental before-and-after study with repeated measures. The scoping review followed the Joanna Briggs Institute and PRISMA-ScR guidelines, with searches conducted in PubMed, Scopus, ScienceDirect, ERIC, and the Virtual Health Library databases. The quasi experimental study was carried out with healthcare professionals from adult Intensive Care Units. The intervention consisted of simulation-based training structured according to RCDP principles, including immediate interruption upon errors, instructional feedback, and task repetition until proficiency was achieved. Theoretical knowledge, technical performance, and participants’ perceptions of the methodology were assessed. Data were analyzed using descriptive and inferential statistics, with a significance level of 5%. Results: The scoping review included 31 studies and demonstrated positive effects of RCDP on technical and non technical skills, self-confidence, and performance of procedures in critical situations. However, gaps remain regarding skill retention, transfer to clinical practice, and impact on patient outcomes. In the quasi-experimental study (n=124), a significant increase in knowledge scores was observed after the intervention (7.60±1.64 vs. 8.14±1.42; p<0.001). Technical performance showed a high overall proficiency level (89.5±5.3), with 90.8% of participants achieving the predefined proficiency criterion. The highest proficiency rates were observed in the domains related to artificial airway management, sedation management, and ventilator weaning. Regarding participants’ perceptions, most strongly agreed that RCDP contributed to the development of skills required for mechanical ventilation management (87.9%), improved technical performance through rapid practice-feedback cycles (87.1%), and increased confidence in applying procedures in clinical practice (91.1%). At the 30-day follow-up (n=13), partial retention of knowledge gains was observed, with lower scores compared to the immediate post-test, although the difference was not statistically significant (p=0.080). Conclusion: RCDP demonstrated potential to improve knowledge, promote high levels of proficiency in the implementation of VAP prevention measures, and strengthen the self confidence of multidisciplinary healthcare professionals in the management of mechanically ventilated patients. These findings support the applicability of RCDP as a continuing education strategy in intensive care and its potential to enhance standardization of clinical practices and patient safety. Nevertheless, limitations related to the short follow-up period and the absence of clinical outcome assessment warrant cautious interpretation of the results.