即时新生儿气管内插管模拟训练：一项随机对照试验。

Just-In-Time Neonatal Endotracheal Intubation Simulation Training: A Randomized Controlled Trial.

机构信息

Division of Neonatology, Department of Pediatrics, Royal Columbian Hospital, New Westminster, BC, Canada.

Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada; Centre for Applied Health Sciences Education (CPASS), Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.

出版信息

J Pediatr. 2023 Oct;261:113576. doi: 10.1016/j.jpeds.2023.113576. Epub 2023 Jun 21.

DOI:10.1016/j.jpeds.2023.113576

PMID:37353151

Abstract

OBJECTIVE

To assess if simulation-based just-in-time training (JITT, short video and simulation) is superior to video training (5-minute video) in acquiring skill in neonatal endotracheal intubation (ETI).

STUDY DESIGN

A Canadian multicenter randomized trial recruited junior residents who performed neonatal ETI from July 2017 to June 2021. The primary outcomes were overall and first attempt ETI success rate. Secondary outcomes included number of attempts, duration of attempts, ETI-related complications, and residents' confidence level. Statistical analysis included generalized estimating equations, mixed model analysis, Mann-Whitney test, and χ² tests.

RESULTS

Sixty-five residents performed 139 ETI. The overall success rate was similar for both groups (67% vs 70%, P = .71). However, the first attempt success rate was higher for the simulation-based JITT group (54% vs 41%, P = .035). The mean duration of attempts was shorter (35 [SD, 9] vs 62 [SD, 9] seconds, P = .048) and the median number of attempts had a tendency to be lower for the simulation-based JITT group (1 [IQR, 1; 1] vs 1 [IQR, 1; 2], P = .02). There were more mucosal trauma events in the simulation-based JITT group (P = .02). Residents in both groups reported similar confidence level in performing ETI.

CONCLUSIONS

Compared with video training, simulation-based JITT for neonatal ETI did not improve overall success rate. However, simulation-based JITT improved first attempt success rate and decreased the number and the duration of ETI attempts. With its positive clinical impact, simulation-based JITT can become an educational adjunct to neonatal ETI training for residents.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02809924.

摘要

目的

评估基于模拟的即时培训（JITT，短视频和模拟）是否优于视频培训（5 分钟视频），以提高新生儿气管内插管（ETI）技能。

研究设计

这是一项加拿大多中心随机试验，招募了 2017 年 7 月至 2021 年 6 月期间进行新生儿 ETI 的初级住院医师。主要结局是整体和首次尝试 ETI 的成功率。次要结局包括尝试次数、尝试持续时间、与 ETI 相关的并发症以及住院医师的信心水平。统计分析包括广义估计方程、混合模型分析、Mann-Whitney 检验和 χ²检验。

结果

65 名住院医师进行了 139 次 ETI。两组的整体成功率相似（67% vs 70%，P=0.71）。然而，基于模拟的 JITT 组的首次尝试成功率更高（54% vs 41%，P=0.035）。尝试的平均持续时间更短（35 [SD，9] 秒 vs 62 [SD，9] 秒，P=0.048），并且基于模拟的 JITT 组尝试的中位数次数也有下降的趋势（1 [IQR，1; 1] 次 vs 1 [IQR，1; 2] 次，P=0.02）。基于模拟的 JITT 组发生更多的黏膜创伤事件（P=0.02）。两组住院医师在进行 ETI 方面报告的信心水平相似。