Rowe Richard, Cohen Ronald A
Departments of Anesthesiology and Diagnostic Imaging, Children's Hospital Oakland, Oakland, CA 94609, USA.
Anesth Analg. 2002 Jul;95(1):62-6, table of contents. doi: 10.1097/00000539-200207000-00011.
In this research, we sought to test the hypothesis that the AccuTouch Flexible Bronchoscopy Simulator (Simulator) is an effective way to teach clinicians the psychomotor skills necessary to use the fiberoptic bronchoscope as an instrument for intubating the trachea of a pediatric patient. Pediatric residents with no prior experience in fiberoptic bronchoscopy were studied. Residents performed fiberoptic intubation on children undergoing general anesthesia. Tapes of these intubations were analyzed for: time to visualization of the carina, and number and time that the bronchoscope tip hit the mucosa. Residents were then trained on the Simulator. Performance of fiberoptic intubation on a subsequent child was compared. Training on the Simulator was the only instruction that the residents received between the two cases. A control group of residents performed two consecutive intubations without training on the Simulator between cases. Residents studied an average of 17 cases, and spent 39 min on the Simulator. Performance was markedly improved after the Simulator. Time to completion of successful intubation with a bronchoscope was reduced from 5.15 to 0.88 min (P < 0.001). The number of times that the tip of the bronchoscope hit the mucosa was reduced from 21.4 to 3.0 (P < 0.001). The amount of time that the resident spent viewing the mucosa decreased from 2.24 to 0.19 min (P < 0.001). The percent of time viewing the channel of the airway increased from 58.5% to 80.4% (P = 0.004). This bronchoscopy simulator was very effective in teaching residents the psychomotor skills necessary for fiberoptic intubation. Significant improvement was seen in time to completion of endotracheal intubation, as well as other performance indicators.
This research showed that the AccuTouch Bronchoscopy Simulator is an effective way to teach the psychomotor skills necessary to intubate the trachea of patients using a fiberoptic bronchoscope. The residents that practiced on the Simulator dramatically improved their skills compared with a control group of residents.
在本研究中，我们试图验证以下假设：AccuTouch 柔性支气管镜模拟器（模拟器）是一种有效的方法，可教会临床医生掌握将纤维支气管镜用作小儿气管插管器械所需的心理运动技能。我们对之前没有纤维支气管镜检查经验的儿科住院医师进行了研究。住院医师对接受全身麻醉的儿童进行纤维支气管镜插管。对这些插管的录像进行分析，记录：隆突可视化时间、支气管镜尖端触及黏膜的次数和时间。然后，住院医师在模拟器上接受培训。比较他们在后续儿童身上进行纤维支气管镜插管的表现。在这两次操作之间，住院医师仅接受了关于模拟器的培训。对照组的住院医师在两次操作之间连续进行两次插管，未接受模拟器培训。住院医师平均研究了17个病例，并在模拟器上花费了39分钟。使用模拟器后，表现有显著改善。使用支气管镜成功完成插管的时间从5.15分钟减少到0.88分钟（P < 0.001）。支气管镜尖端触及黏膜的次数从21.4次减少到3.0次（P < 0.001）。住院医师观察黏膜的时间从2.24分钟减少到0.19分钟（P < 0.001）。观察气道通道的时间百分比从58.5%增加到80.4%（P = 0.004）。这种支气管镜模拟器在教授住院医师纤维支气管镜插管所需的心理运动技能方面非常有效。在气管插管完成时间以及其他表现指标方面都有显著改善。
本研究表明，AccuTouch支气管镜模拟器是一种有效的方法，可教会临床医生掌握使用纤维支气管镜进行气管插管所需的心理运动技能。与对照组住院医师相比，在模拟器上练习的住院医师技能有显著提高。
