Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark.
Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Anaesthesia. 2021 Oct;76(10):1404-1415. doi: 10.1111/anae.15375. Epub 2021 Jan 26.
Major complications associated with airway management are rare but often have serious consequences. Complications frequently result from failures in communication and teamwork. We performed a systematic review on the effect of simulation-based team training on patient outcomes, healthcare professionals' clinical performance and preparedness for airway management. We included studies with simulation-based team training in airway management as the educational intervention, using any comparator, outcome and design. Two authors independently selected articles and assessed risk of bias using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education. We screened 1248 titles and evaluated 116 full-text articles. Twenty-two studies were included. The Kirkpatrick model for evaluation of training was used to organise outcomes. Four studies reported patient-centred outcomes (Kirkpatrick level 4), and three studies' outcomes related to healthcare professionals' clinical performance (Kirkpatrick level 3). The results were ambiguous and the studies had significant methodological limitations, making it difficult to draw conclusions on the effect of simulation-based team training. To describe preparedness for airway management, we used outcomes related to participants' attitudes or perceptions and outcomes related to knowledge or skills demonstrated in a test setting (Kirkpatrick level 2). Most studies reporting these outcomes were in favour of simulation-based team training, but were prone to bias. We consider the current evidence to be weak and recommend that future research should be based on randomised study designs and patient-centred outcomes.
与气道管理相关的主要并发症虽不常见，但往往后果严重。这些并发症通常是由于沟通和团队协作失败所致。我们就基于模拟的团队培训对患者结局、医疗保健专业人员的临床表现和气道管理准备情况的影响进行了系统评价。我们纳入了气道管理中基于模拟的团队培训作为教育干预的研究，使用任何对照、结局和设计。两位作者独立选择文章，并使用医学教育研究质量工具和纽卡斯尔-渥太华量表-教育来评估偏倚风险。我们筛选了 1248 个标题，并评估了 116 篇全文文章。22 项研究被纳入。我们使用评估培训的 Kirkpatrick 模型来组织结局。四项研究报告了以患者为中心的结局（Kirkpatrick 第 4 级），三项研究的结局与医疗保健专业人员的临床表现相关（Kirkpatrick 第 3 级）。结果模棱两可，且这些研究存在显著的方法学局限性，使得难以就基于模拟的团队培训的效果得出结论。为了描述气道管理的准备情况，我们使用了与参与者的态度或看法相关的结局以及在测试环境中展示的知识或技能相关的结局（Kirkpatrick 第 2 级）。大多数报告这些结局的研究都支持基于模拟的团队培训，但容易出现偏倚。我们认为目前的证据较弱，并建议未来的研究应基于随机研究设计和以患者为中心的结局。
