基于虚拟角色的危重症麻醉事件患者监测：一项随机高保真模拟研究

Avatar-based patient monitoring in critical anaesthesia events: a randomised high-fidelity simulation study.

作者信息

Roche Tadzio R, Said Sadiq, Braun Julia, Maas Elise J C, Machado Carl, Grande Bastian, Kolbe Michaela, Spahn Donat R, Nöthiger Christoph B, Tscholl David W

机构信息

Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.

Department of Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.

出版信息

Br J Anaesth. 2021 May;126(5):1046-1054. doi: 10.1016/j.bja.2021.01.015. Epub 2021 Apr 8.

DOI:10.1016/j.bja.2021.01.015

PMID:33879327

Abstract

BACKGROUND

Failures in situation awareness cause two-thirds of anaesthesia complications. Avatar-based patient monitoring may promote situation awareness in critical situations.

METHODS

We conducted a prospective, randomised, high-fidelity simulation study powered for non-inferiority. We used video analysis to grade anaesthesia teams managing three 10 min emergency scenarios using three randomly assigned monitoring modalities: only conventional, only avatar, and split-screen showing both modalities side by side. The primary outcome was time to performance of critical tasks. Secondary outcomes were time to verbalisation of vital sign deviations and the correct cause of the emergency, perceived workload, and usability. We used mixed Cox and linear regression models adjusted for various potential confounders. The non-inferiority margin was 10%, or hazard ratio (HR) 0.9.

RESULTS

We analysed 52 teams performing 154 simulations. For performance of critical tasks during a scenario, split-screen was non-inferior to conventional (HR=1.13; 95% confidence interval [CI], 0.96-1.33; not significant in test for superiority); the result for avatar was inconclusive (HR=0.98; 95% CI, 0.83-1.15). Avatar was associated with a higher probability for verbalisation of the cause of the emergency (HR=1.78; 95% CI, 1.13-2.81; P=0.012). We found no evidence for a monitor effect on perceived workload. Perceived usability was lower for avatar (coefficient=-23.0; 95% CI, -27.2 to -18.8; P<0.0001) and split-screen (-6.7; 95% CI, -10.9 to -2.4; P=0.002) compared with conventional.

CONCLUSIONS

This study showed non-inferiority of split-screen compared with conventional monitoring for performance of critical tasks during anaesthesia crisis situations. The patient avatar improved verbalisation of the correct cause of the emergency. These results should be interpreted considering participants' minimal avatar but extensive conventional monitoring experience.

摘要

背景

情境意识失误导致三分之二的麻醉并发症。基于化身的患者监测可能会在危急情况下提高情境意识。

方法

我们进行了一项前瞻性、随机、高保真模拟研究，以检验非劣效性。我们使用视频分析对麻醉团队在三种10分钟紧急场景中的表现进行评分，这些团队使用三种随机分配的监测方式：仅传统监测、仅化身监测以及分屏同时显示两种监测方式。主要结局是关键任务的执行时间。次要结局包括生命体征偏差及紧急情况正确原因的言语表达时间、感知工作量和可用性。我们使用了经各种潜在混杂因素调整的混合Cox模型和线性回归模型。非劣效性界值为10%，即风险比（HR）为0.9。

结果

我们分析了52个团队进行的154次模拟。在场景中执行关键任务时，分屏监测与传统监测非劣效（HR = 1.13；95%置信区间[CI]，0.96 - 1.33；优越性检验无显著性差异）；化身监测的结果尚无定论（HR = 0.98；95% CI，0.83 - 1.15）。化身监测与紧急情况原因言语表达的较高概率相关（HR = 1.78；95% CI，1.13 - 2.81；P = 0.012）。我们没有发现监测方式对感知工作量有影响的证据。与传统监测相比，化身监测（系数 = -23.0；95% CI，-27.2至-18.8；P < 0.0001）和分屏监测（-6.7；95% CI，-10.9至-2.4；P = 0.002）的感知可用性较低。