From the Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan.
School of Medicine, University of Michigan, Ann Arbor, Michigan.
Anesth Analg. 2020 Feb;130(2):445-451. doi: 10.1213/ANE.0000000000003774.
Pediatric-specific difficult airway guidelines include algorithms for 3 scenarios: unanticipated difficult tracheal intubation, difficult mask ventilation, and cannot intubate/cannot ventilate. While rare, these instances may require front-of-neck access (FONA) to secure an airway until a definitive airway can be established. The aim of this study was to develop a pediatric FONA simulator evaluated by both anesthesiology and otolaryngology providers, promoting multidisciplinary airway management.
A 3-dimensional-printed tracheal model was developed using rescaled, anatomically accurate dimensions from a computerized tomography scan using computer-aided design software. The medical grade silicone model was incorporated into a mannequin to create a low-cost, high-fidelity simulator. A multidisciplinary team of anesthesiology, otolaryngology, and simulation experts refined the model. Experts in airway management were recruited to rate the realism of the model's characteristics and features and their own ability to complete specific FONA-related tasks.
Six expert raters (3 anesthesiology and 3 otolaryngology) were identified for multidisciplinary evaluation of model test content validity. Analysis of response data shows null variance within 1 or both specialties for a majority of the content validity tool elements. High and consistent absolute ratings for each domain indicate that the tested experts perceived this trainer as a realistic and highly valuable tool in its current state.
The ability to practice front-of-neck emergency airway procedures safely and subsequently demonstrate proficiency on a child model has great implications regarding both quality of physician training and patient outcomes. This model may be incorporated into curricula to teach needle cricothyroidotomy and other FONA procedures to providers across disciplines.
儿科特定的困难气道指南包括三种情况的算法：意外的困难气管插管、困难面罩通气和无法插管/无法通气。虽然很少见，但这些情况可能需要进行前颈部通道（FONA）以确保气道安全，直到可以建立明确的气道。本研究的目的是开发一种儿科 FONA 模拟器，由麻醉科和耳鼻喉科医生共同评估，以促进多学科气道管理。
使用计算机辅助设计软件，根据计算机断层扫描的缩放、解剖准确尺寸，开发了一个 3 维打印的气管模型。将医用级硅树脂模型整合到一个模拟人上，创建了一个低成本、高保真的模拟器。一个由麻醉科、耳鼻喉科和模拟专家组成的多学科团队对模型进行了改进。招募了气道管理专家，对模型的特征和特征的逼真度以及他们自己完成特定的 FONA 相关任务的能力进行评分。
确定了 6 名专家评分者（3 名麻醉科医生和 3 名耳鼻喉科医生），对模型测试的内容有效性进行多学科评估。对响应数据的分析表明，大多数内容有效性工具要素的专业差异或两者之间的方差为零。每个领域的高且一致的绝对评分表明，测试专家认为该培训师在当前状态下是一种现实且极具价值的工具。
安全地进行前颈部紧急气道程序的实践，并随后在儿童模型上展示熟练程度，这对医生培训质量和患者预后都有很大的影响。该模型可纳入课程，教授跨学科的医生进行针状环甲膜切开术和其他 FONA 程序。
