From the Department of Anesthesiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
Simul Healthc. 2019 Jun;14(3):163-168. doi: 10.1097/SIH.0000000000000368.
The aims of this randomized prospective mannequin study were to determine the amount of attempts required for successful intubation using different fiberscopes (Bonfils and SensaScope) by inexperienced anesthesiologists in a difficult airway scenario and to build the associated learning curves.
Difficult airway simulation was achieved with tongue edema in mannequin. After approval of volunteers, we asked 15 anesthesiology residents without any experience with fiberscopes to intubate with each device in a random order. Intubation success (endotracheal intubation within 120 seconds), the degree of difficulty of intubation, and reality of simulation using a 10-point scale were recorded. Learning curves were generated with cumulative sum method.
With Bonfils, 13 volunteers were able to pass lower decision boundary with a median number of 26 [95% confidence interval (CI) = 21.4-25.9] attempts, whereas in SensaScope, the same outcome was observed in 10 residents with a median number of attempts of 26 (95% CI = 23.5-32.5). Total success rate was found significantly higher with Bonfils compared with SensaScope (550/600 vs 512/600, respectively, P < 0.001). Intubation with Bonfils was considered as less difficult compared with SensaScope [median = 4 (95% CI = 3.32-4.42) and 6 (95% CI = 4.96-6.64), P = 0.01, respectively]. The reality of the simulation was rated as a median of 5 (95% CI = 4.37-5.8).
Although a similar number of attempts were required to reach predetermined competency for both fiberscopes, only 10 of residents were able to obtain the targeted success using SensaScope as compared with 13 with Bonfils. Inexperienced residents found intubation via Bonfils less difficult than SensaScope. High individual variability in obtaining competency observed in this study with cumulative sum analysis underlines the importance of defining success a priori to simulation, the need for follow-up of individual progress, and the need to offer adequate trials to achieve competency. Therefore, learning opportunities should be adapted accordingly.
本随机前瞻性模拟研究的目的是确定在困难气道情况下，经验不足的麻醉师使用不同纤维镜（Bonfils 和 SensaScope）进行成功插管所需的尝试次数，并构建相关的学习曲线。
在模拟中通过人工造成舌体肿胀来建立困难气道。在志愿者获得批准后，我们要求 15 名没有使用纤维镜经验的麻醉学住院医师随机使用每种设备进行插管。记录插管成功（120 秒内完成气管内插管）、插管难度程度以及使用 10 分制评估模拟的真实性。使用累积和法生成学习曲线。
使用 Bonfils，13 名志愿者能够通过下决策边界，中位数为 26（95%置信区间 [95%CI] = 21.4-25.9）次尝试，而在 SensaScope 中，10 名志愿者中有同样结果，中位数为 26 次尝试（95%CI = 23.5-32.5）。与 SensaScope 相比，Bonfils 的总成功率显著更高（分别为 550/600 与 512/600，P < 0.001）。与 SensaScope 相比，使用 Bonfils 进行插管被认为难度较低[中位数=4（95%CI = 3.32-4.42）和 6（95%CI = 4.96-6.64），P = 0.01]。模拟的真实性被评为中位数 5（95%CI = 4.37-5.8）。
尽管达到预定能力所需的尝试次数对于两种纤维镜来说相似，但与 Bonfils 相比，只有 10 名住院医师能够使用 SensaScope 达到目标成功率。与 SensaScope 相比，经验不足的住院医师发现使用 Bonfils 进行插管的难度较低。在这项研究中，使用累积和分析观察到个体在获得能力方面的个体差异很大，这突出了在模拟前预先定义成功的重要性、需要跟踪个体进展以及需要提供足够的尝试机会以达到能力的重要性。因此，学习机会应相应地进行调整。
