Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China.
Shanddong First Medical University, Shandong, China.
PLoS One. 2023 Jul 13;18(7):e0288617. doi: 10.1371/journal.pone.0288617. eCollection 2023.
Endotracheal intubation with a flexible bronchoscope is a well-recognized airway management technique that anesthesiologists must master. Skill acquisition and knowledge must reach an appropriate level before trainees perform independent practice on patients. There are a paucity of evidence-based outcome measures of trainee competence in performing flexible bronchoscopy. The objectives of this study were to 1) construct a learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents using the CUSUM method and 2) determine the number of procedures required to achieve proficiency.
This study included 12 first-year anesthesiology residents with no previous experience with flexible bronchoscopic intubation. Trainees attended theoretical and simulation training and performed flexible bronchoscope-guided orotracheal intubation in adult patients with normal airways under general anesthesia. Number of intubation attempts, intubation success rate, time to intubation, and incidence of dental and mucosal injuries were recorded. The cumulative sum (CUSUM) method was used to evaluate the learning curve of flexible bronchoscope-guided orotracheal intubation.
Trainees performed flexible bronchoscope-guided orotracheal intubation on 364 patients. First-attempt intubation success occurred in 317 (87.1%) patients. Second-attempt intubation success occurred in 23 (6.3%) patients. Overall, the flexible bronchoscope-guided orotracheal intubation success rate was 93.4% (range, 85.3% to 100%). The mean number of orotracheal intubation procedures per trainee was 31 ± 5 (range, 23 to 40). All trainees crossed the lower decision boundary (H0) after 15.1 ± 5.6 procedures (range, 8 to 25 procedures). There was a significant decrease in median intubation time [39s (IQR: 30, 50) vs. 76s (IQR: 54, 119)] (P < 0.001) after crossing the lower decision boundary (H0) compared to before. There were no dental, mucosa, arytenoid or vocal cord trauma events associated with intubation.
Learning curves constructed with CUSUM analysis showed that all trainees (anesthesiologist residents) included in this study achieved competence (intubation success rates ≥ 80%) in flexible bronchoscope-guided orotracheal intubation. Trainees needed to perform 15 (range, 8 to 25) procedures to achieve proficiency. There was wide variability between trainees.
Trial registration: Chinese Clinical Trial Register, ChiCTR 2000032166.
经纤维支气管镜引导行气管插管是一种公认的气道管理技术，麻醉师必须掌握。在学员对患者进行独立操作之前，技能的获得和知识必须达到适当的水平。在对行纤维支气管镜引导下经口气管插管的学员能力进行评估方面，缺乏基于证据的结果衡量标准。本研究的目的是：1）使用累积和（CUSUM）方法为麻醉住院医师构建纤维支气管镜引导下经口气管插管的学习曲线，2）确定达到熟练程度所需的操作次数。
本研究纳入了 12 名无纤维支气管镜插管经验的第一年麻醉住院医师。培训生参加了理论和模拟培训，并在全身麻醉下对气道正常的成年患者进行纤维支气管镜引导下经口气管插管。记录插管尝试次数、插管成功率、插管时间以及牙齿和粘膜损伤的发生率。使用累积和（CUSUM）方法评估纤维支气管镜引导下经口气管插管的学习曲线。
培训生对 364 名患者进行了纤维支气管镜引导下经口气管插管。首次尝试插管成功率为 317 例（87.1%）。第二次尝试插管成功率为 23 例（6.3%）。总体而言，纤维支气管镜引导下经口气管插管的成功率为 93.4%（范围，85.3%至 100%）。每名培训生的平均经口气管插管次数为 31 ± 5 次（范围，23 至 40 次）。所有培训生在 15.1 ± 5.6 次操作后（范围，8 至 25 次操作）均越过了较低的决策边界（H0）。与越过较低决策边界（H0）之前相比，中位插管时间显著缩短[39s（IQR：30，50）vs. 76s（IQR：54，119）]（P<0.001）。与插管相关的牙齿、粘膜、杓状软骨或声带损伤事件无发生。
使用 CUSUM 分析构建的学习曲线表明，纳入本研究的所有培训生（麻醉住院医师）在纤维支气管镜引导下经口气管插管方面均达到了熟练程度（插管成功率≥80%）。培训生需要进行 15 次（范围，8 至 25 次）操作才能达到熟练程度。培训生之间存在很大的差异。
临床试验注册：中国临床试验注册中心，ChiCTR2000032166。
