van Haperen Maartje, Kemper Tom C P M, Hermanides Jeroen, Eberl Susanne, Hollmann Markus W, Breel Jennifer S, Preckel Benedikt
Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, 1105AZ Amsterdam, The Netherlands.
J Clin Med. 2023 Aug 9;12(16):5195. doi: 10.3390/jcm12165195.
The appropriate management of a "difficult airway" remains a challenge for novices and experienced anaesthetists. With the current available airway technologies, e.g., video laryngoscopy, flexible bronchoscopy (fibreoptic intubation (FOI)) for endotracheal intubation is decreasing, likely diminishing caregiver skills. We investigated whether bronchoscopy simulator training improved FOI skills.
72 volunteers, consisting of anaesthetists, anaesthesia residents, and nurses, performed six exercises on a bronchoscopy simulator. At baseline and after 12 months, the six exercises included one serious game (to train agility), two basic airways, and three difficult airways. After a baseline assessment, subjects were randomly allocated to the intervention group (with) or control group without bronchoscopy simulator training every six weeks for 10 min using a preloaded serious game. The primary outcome was the difference in the time to reach the carina after 12 months, as measured objectively by the simulator. The level of stress and FOI confidence after 12 months were secondary outcomes.
The control and intervention groups had a similar time to reach the carina in difficult airway cases and the reported stress levels, at baseline and 12 months, showed no difference. In contrast, the intervention group's self-reported confidence in FOI skills improved more.
Although participants rated higher in confidence, practicing FOI skills on an airway simulator with an agility game did not increase their performance in simulated challenging airway instances.
对于新手和经验丰富的麻醉医生而言，“困难气道”的恰当处理仍是一项挑战。随着当前可用的气道技术，例如视频喉镜的出现，用于气管插管的柔性支气管镜检查（纤维光导插管术（FOI））正在减少，这可能会降低医护人员的相关技能。我们研究了支气管镜模拟器训练是否能提高纤维光导插管术技能。
72名志愿者，包括麻醉医生、麻醉住院医师和护士，在支气管镜模拟器上进行六项练习。在基线期和12个月后，这六项练习包括一项严肃游戏（用于训练敏捷性）、两项基本气道练习和三项困难气道练习。在基线评估后，受试者被随机分配到干预组（接受）或对照组（不接受），每六周使用预加载的严肃游戏进行10分钟的支气管镜模拟器训练。主要结局是12个月后到达隆突的时间差异，由模拟器客观测量。12个月后的压力水平和纤维光导插管术信心是次要结局。
在困难气道病例中，对照组和干预组到达隆突的时间相似，并且在基线期和12个月时报告的压力水平无差异。相比之下，干预组自我报告的纤维光导插管术技能信心提高得更多。
尽管参与者的信心评分更高，但在带有敏捷性游戏的气道模拟器上练习纤维光导插管术技能并未提高他们在模拟挑战性气道情况下的表现。
