Chandra Deven B, Savoldelli Georges L, Joo Hwan S, Weiss Israel D, Naik Viren N
Department of Anesthesiology, St. Michael's Hospital, University of Toronto, Canada.
Anesthesiology. 2008 Dec;109(6):1007-13. doi: 10.1097/ALN.0b013e31818d6c3c.
Previous studies have indicated that fiberoptic orotracheal intubation (FOI) skills can be learned outside the operating room. The purpose of this study was to determine which of two educational interventions allows learners to gain greater capacity for performing the procedure.
Respiratory therapists were randomly assigned to a low-fidelity or high-fidelity training model group. The low-fidelity group was guided by experts, on a nonanatomic model designed to refine fiberoptic manipulation skills. The high-fidelity group practiced their skills on a computerized virtual reality bronchoscopy simulator. After training, subjects performed two consecutive FOIs on healthy, anesthetized patients with predicted "easy" intubations. Each subject's FOI was evaluated by blinded examiners, using a validated global rating scale and checklist. Success and time were also measured.
Data were analyzed using a two-way mixed design analysis of variance. There was no significant difference between the low-fidelity (n = 14) and high-fidelity (n = 14) model groups when compared with the global rating scale, checklist, time, and success at achieving tracheal intubation (all P = not significant). Second attempts in both groups were significantly better than first attempts (P < 0.001), and there was no interaction between "fidelity of training model" and "first versus second attempt" scores.
There was no added benefit from training on a costly virtual reality model with respect to transfer of FOI skills to intraoperative patient care. Second attempts in both groups were significantly better than first attempts. Low-fidelity models for FOI training outside the operating room are an alternative for programs with budgetary constraints.
先前的研究表明，纤维光学经口气管插管（FOI）技能可以在手术室之外学习。本研究的目的是确定两种教育干预措施中的哪一种能让学习者获得更强的操作该程序的能力。
呼吸治疗师被随机分配到低保真或高保真训练模型组。低保真组由专家指导，在一个旨在完善纤维光学操作技能的非解剖模型上进行训练。高保真组在计算机化虚拟现实支气管镜模拟器上练习技能。训练后，受试者对预计“容易”插管的健康麻醉患者连续进行两次FOI操作。由不知情的检查人员使用经过验证的整体评分量表和检查表对每个受试者的FOI操作进行评估。同时记录成功率和操作时间。
采用双向混合设计方差分析对数据进行分析。在整体评分量表、检查表、操作时间以及气管插管成功率方面，低保真组（n = 14）和高保真组（n = 14）之间没有显著差异（所有P值均无统计学意义）。两组的第二次尝试均显著优于第一次尝试（P < 0.001），并且“训练模型的逼真度”与“第一次与第二次尝试”得分之间没有交互作用。
就将FOI技能应用于术中患者护理而言，在昂贵的虚拟现实模型上进行训练并无额外益处。两组的第二次尝试均显著优于第一次尝试。对于预算有限的项目，手术室之外的低保真FOI训练模型是一种替代方案。
