A home-made animal model in comparison with a standard manikin for teaching percutaneous dilatational tracheostomy

Fiorelli, Alfonso; Carelli, E; Angioletti, D.; Orsini, A; D’Elia, A; Torino, Annarita; Santini, Mario; Ferraro, Fausto

doi:10.1093/icvts/ivu382

Cited by 13 publications

(5 citation statements)

References 17 publications

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“…To the best of our knowledge, this is the first study reporting a simulation-based training protocol for BG-PDT. Previous experiences only focused on PDT simulator design and user satisfaction, [41][42][43] but no comprehensive skill assessment and protocolized training had been performed. Many procedural similarities between PDT and CVC installation can be drawn.…”

Section: Discussionmentioning

confidence: 99%

Simulation-Based Mastery Learning of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy

et al. 2020

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Introduction: Although simulation-based training has demonstrated improvement of procedural skills and clinical outcomes in different procedures, there are no published training protocols for bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT). The objective of this study was to assess the acquisition of BG-PDT procedural competency with a simulation-based mastery learning training program, and skills transfer into cadaveric models. Methods: Using a prospective interventional design, 8 trainees naive to the procedure were trained in a simulation-based mastery learning BG-PDT program. Students were assessed using a multimodal approach, including blind global rating scale (GRS) scores of video-recorded executions, total procedural time, and hand-motion tracking-derived parameters. The BG-PDT mastery was defined as proficient tracheostomy (successful procedural performance, with less than 3 puncture attempts, and no complications) with GRS scores higher than 21 points (of 25). After mastery was achieved in the simulator, residents performed 1 BG-PDT execution in a cadaveric model. Results: Compared with baseline, in the final training session, residents presented a higher procedural proficiency (0% vs. 100%, P < 0.001), with higher GRS scores [8 (6-8) vs. 25 (24-25), P = 0.01] performed in less time [563 (408-600) vs. 246 (214-267), P = 0.01] and with higher movement economy. Procedural skills were further transferred to the cadaveric model. Conclusions: Residents successfully acquired BG-PDT procedural skills with a simulation-based mastery learning training program, and skills were effectively transferred to a cadaveric model. This easily replicable program is the first simulation-based BG-PDT training experience reported in the literature, enhancing safe competency acquisition, to further improve patient care.

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Section: Discussionmentioning

confidence: 99%

Simulation-Based Mastery Learning of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy

et al. 2020

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“…As a consequence, PDT could expose HCWs to aerosol leaks during the entire procedure. Ex-vivo swine model has already been used for ST [ 45 ], PDT training [ 46 ] and aerosol quantification [ 47 , 48 ]. In the swine model, it is not possible to simulate all the anatomical difficulties that can be encountered during a tracheostomy and that may greatly affect the safety of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Measurement of airborne particle emission during surgical and percutaneous dilatational tracheostomy COVID-19 adapted procedures in a swine model: Experimental report and review of literature

et al. 2022

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Introduction Surgical tracheostomy (ST) and Percutaneous dilatational tracheostomy (PDT) are classified as high-risk aerosol-generating procedures and might lead to healthcare workers (HCW) infection. Albeit the COVID-19 strain slightly released since the vaccination era, preventing HCW from infection remains a major economical and medical concern. To date, there is no study monitoring particle emissions during ST and PDT in a clinical setting. The aim of this study was to monitor particle emissions during ST and PDT in a swine model. Methods A randomized animal study on swine model with induced acute respiratory distress syndrome (ARDS) was conducted. A dedicated room with controlled airflow was used to standardize the measurements obtained using an airborne optical particle counter. 6 ST and 6 PDT were performed in 12 pigs. Airborne particles (diameter of 0.5 to 3 μm) were continuously measured; video and audio data were recorded. The emission of particles was considered as significant if the number of particles increased beyond the normal variations of baseline particle contamination determinations in the room. These significant emissions were interpreted in the light of video and audio recordings. Duration of procedures, number of expiratory pauses, technical errors and adverse events were also analyzed. Results 10 procedures (5 ST and 5 PDT) were fully analyzable. There was no systematic aerosolization during procedures. However, in 1/5 ST and 4/5 PDT, minor leaks and some adverse events (cuff perforation in 1 ST and 1 PDT) occurred. Human factors were responsible for 1 aerosolization during 1 PDT procedure. ST duration was significantly shorter than PDT (8.6 ± 1.3 vs 15.6 ± 1.9 minutes) and required less expiratory pauses (1 vs 6.8 ± 1.2). Conclusions COVID-19 adaptations allow preventing for major aerosol leaks for both ST and PDT, contributing to preserving healthcare workers during COVID-19 outbreak, but failed to achieve a perfectly airtight procedure. However, with COVID-19 adaptations, PDT required more expiratory pauses and more time than ST. Human factors and adverse events may lead to aerosolization and might be more frequent in PDT.

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“…Thus, we planned an experimental study to evaluate whether the ETView tube could be a valuable alternative to bronchoscopy to perform PDT, an issue not previously reported. The procedure was performed in a home-made animal model, previously used by our group for teaching PDT 9 . Unlike our previous experience, in the present study the ETView tube was used instead of bronchoscopy to see the different manoeuvres of the PDT in real time.…”

Section: Discussionmentioning

confidence: 99%

“…Our group recently described the assessment of an experimental animal model 9 . Briefly, the model involved the placement of a porcine laryngotracheal block on a hard backing.…”

Section: Experimental Pig Modelmentioning

confidence: 99%

Percutaneous Dilatational Tracheostomy using a Tracheoscopic Ventilation Tube in an Experimental ex Vivo Animal Model

Fiorelli

Ferraro

Milione

et al. 2016

Anaesth Intensive Care

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The ETView® tube is a standard endotracheal tube with an embedded miniature video camera that permits real-time video imaging of the tracheal lumen. We evaluated its use when performing percutaneous dilatational tracheostomy (PDT) in an ex vivo animal model. The model consisted of a pig larynyx and trachea. The ETView tube was used as an alternative to bronchoscopy, to see all manoeuvres of PDT in real time. At the end of the PDT, operative time and any complications such as trauma to the cricoid cartilage, tracheal wall or tube cuff were assessed. Nine PDT procedures were performed by two experienced operators. The mean operative time was 7.1 ± 0.9 minutes. No complications were observed. Our study supports the use of the ETView tube as a suitable alternative to bronchoscopy when performing PDT, although clinical studies are required to confirm our experimental results.

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A home-made animal model in comparison with a standard manikin for teaching percutaneous dilatational tracheostomy

Cited by 13 publications

References 17 publications

Simulation-Based Mastery Learning of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy

Simulation-Based Mastery Learning of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy

Measurement of airborne particle emission during surgical and percutaneous dilatational tracheostomy COVID-19 adapted procedures in a swine model: Experimental report and review of literature

Percutaneous Dilatational Tracheostomy using a Tracheoscopic Ventilation Tube in an Experimental ex Vivo Animal Model

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