Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia.
BMC Emerg Med. 2023 Jun 10;23(1):66. doi: 10.1186/s12873-023-00832-8.
This study aimed to compare the heart rate response to stress during airway intubations in clinical practice and a simulated environment.
Twenty-five critical care registrars participated in the study over a 3-month period. Heart rate data during intubations was recorded by a FitBit® Charge 2 worn by each participant during their clinical practice, and during a single simulated airway management scenario. The heart rate range was calculated by subtracting the baseline working heart rate (BWHR) from the maximum functional heart rate (MFHR). For each airway intubation performed participants recorded an airway diary entry. Data from intubations performed in the clinical environment was compared to data from a simulated environment. Heart rate changes were observed in two ways: percentage rise (median) across the 20-min intubation period and; percentage rise at point of intubation (median).
Eighteen critical care registrars completed the study, mean age 31.8 years (SD = 2.015, 95% CI = 30.85-32.71). Throughout the 20-min peri-intubation recording period there was no significant difference in the median change in heart rates between the clinical (14.72%) and simulation (15.96%) environment (p = 0.149). At the point of intubation there was no significant difference in the median change in heart rate between the clinical (16.03%) and the simulation (25.65%) environment groups (p = 0.054).
In this small population of critical care trainees, a simulation scenario induced a comparable heart rate response to the clinical environment during intubation. This provides evidence that simulation scenarios are able to induce a comparable physiological stress response to the clinical environment and thus facilitates effective teaching of a high-risk procedure in a safe manner.
本研究旨在比较临床实践和模拟环境中气道插管时的心率应激反应。
在 3 个月的时间里，25 名重症监护住院医师参与了这项研究。每位参与者在临床实践和单次模拟气道管理场景中佩戴 FitBit®Charge 2 记录心率数据。心率范围通过从最大功能心率 (MFHR) 中减去基线工作心率 (BWHR) 来计算。对于进行的每一次气道插管，参与者都记录了气道日记条目。将临床环境中进行的气道插管的数据与模拟环境中的数据进行比较。通过两种方式观察心率变化：整个 20 分钟插管期间的百分比升高（中位数）和；插管时的百分比升高（中位数）。
18 名重症监护住院医师完成了这项研究，平均年龄 31.8 岁（标准差 = 2.015，95%置信区间 = 30.85-32.71）。在整个插管前 20 分钟记录期间，临床（14.72%）和模拟（15.96%）环境中心率中位数变化没有显著差异（p = 0.149）。在插管时，临床（16.03%）和模拟（25.65%）环境组中心率中位数变化没有显著差异（p = 0.054）。
在这一小部分重症监护培训师中，模拟场景在插管过程中引起的心率反应与临床环境相当。这表明模拟场景能够引起与临床环境相当的生理应激反应，从而以安全的方式有效地教授高风险程序。
