Bronchial blocker positioning: learning curve and confidence in its use

Rispoli, Marco; Zani, Gianluca; Bizzarri, Federico; Nespoli, M; Mattiacci, Dario Maria; Agnoletti, Vanni; Fiorelli, Alfonso; Corcione, Antonio; Buono, Salvatore

doi:10.23736/s0375-9393.18.12390-x

Cited by 6 publications

(4 citation statements)

References 18 publications

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“…Despite dedicated ports on airway connectors, with differently effective sealing options, disconnections and bronchoscopy could expose the operator to biological risk. Also, BBs require a certain expertise, and it has been found that at least 15 procedures are necessary to develop a satisfactory and safe level of confidence with these devices [ 11 ]. Developing such a skill during a COVID-19 pandemic is someway dangerous, so we strongly discourage adoption of this technique for non-skilled users.…”

Section: Discussionmentioning

confidence: 99%

Airway management for one lung ventilation during COVID-19 pandemic: a survey within Italian anesthesiologists

Rispoli

Piccioni

Giacinto

et al. 2022

J Anesth Analg Crit Care

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Background Airway management for thoracic surgery represents a high risk setting for SARS-CoV-2 infection diffusion due to complex and invasive airway instrumentation and techniques. Results An 18-item questionnaire was submitted to the 56 members of the Thoracic subcommittee of the SIAARTI Cardio-Thoraco-Vascular Research Group to provide a snapshot of current situation and national variability of devices and procedures for airway management during the COVID-19 pandemic. The response rate was 64%. Eighty-three percent of anesthetists declared that they modified their airway management strategies. The Hospital Management considered necessary to provide a complete level 3 personal protective equipment for thoracic anesthetists only in 47% of cases. Double-lumen tube and bronchial blocker were preferred by 53% and 22% of responders to achieve one-lung ventilation respectively. Over 90% of responders considered the videolaryngoscope with separate screen and rapid sequence induction/intubation useful to minimize the infection risk. Thirty-nine percent of participants considered mandatory the bronchoscopic check of airway devices. Vivasight-DL was considered comfortable by more than 50% of responders while protective box and plastic drape were judged as uncomfortable by most of anesthetists. Conclusions The survey reveals many changes in the clinical practice due to SARS-CoV-2 outbreak. A certain diffusion of new devices such as the VivaSight-DL and barrier enclosure systems emerged too. Finally, we found that most of Italian hospitals did not recognize thoracic anesthesia as a high-risk specialty for risk of virus diffusion.

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Section: Discussionmentioning

confidence: 99%

Airway management for one lung ventilation during COVID-19 pandemic: a survey within Italian anesthesiologists

Rispoli

Piccioni

Giacinto

et al. 2022

J Anesth Analg Crit Care

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“…It has been shown that 6 bronchial blockers placements are enough to significantly improve provider dexterity. However, 15 uses are required to acquire adequate skills for the correction of mispositioned blockers [ 7 ]. This emphasises the need for regular hands-on training and bronchial blocker use to acquire and maintain the necessary skills.…”

Section: Discussionmentioning

confidence: 99%

Current practice of thoracic anaesthesia in Europe – a survey by the European Society of Anaesthesiology Part I – airway management and regional anaesthesia techniques

et al. 2021

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Background The scientific working group for “Anaesthesia in thoracic surgery” of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) has performed an online survey to assess the current standards of care and structural properties of anaesthesia workstations in thoracic surgery. Methods All members of the European Society of Anaesthesiology (ESA) were invited to participate in the study. Results Thoracic anaesthesia was most commonly performed by specialists/board-certified anaesthetists and/or senior/attending physicians. Across Europe, the double lumen tube (DLT) was most commonly chosen as the primary device for lung separation (461/ 97.3%). Bronchial blockers were chosen less frequently (9/ 1.9%). Throughout Europe, bronchoscopy was not consistently used to confirm correct double lumen tube positioning. Respondents from Eastern Europe (32/ 57.1%) frequently stated that there were not enough bronchoscopes available for every intrathoracic operation. A specific algorithm for difficult airway management in thoracic anaesthesia was available to only 18.6% (n = 88) of the respondents. Thoracic epidural analgesia (TEA) is the most commonly used form of regional analgesia for thoracic surgery in Europe. Ultrasonography was widely available 93,8% (n = 412) throughout Europe and was predominantly used for central line placement and lung diagnostics. Conclusions While certain „gold standards “are widely met, there are also aspects of care requiring substantial improvement in thoracic anaesthesia throughout Europe. Our data suggest that algorithms and standard operating procedures for difficult airway management in thoracic anaesthesia need to be established. A European recommendation for the basic requirements of an anaesthesia workstation for thoracic anaesthesia is expedient and desirable, to improve structural quality and patient safety.

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“…1 ) [ 14 ]. Readiness, in turn, may be influenced by the number of skill repetitions previously carried out [ 24 , 32 ]. Hence, the level of learning behavior may increase, and it appeared that teaching styles and supervision levels should be selected independently of the duration of training and postgraduate year.…”

Section: Discussionmentioning

confidence: 99%

Learner-centered education: ICU residents’ expectations of teaching style and supervision level

Zante

Klasen

2021

BMC Med Educ

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Background If the education of intensive care unit (ICU) residents focuses on individual learning behavior, the faculty’s style of teaching and level of supervision need to be adapted accordingly. The aim of this study was to delineate the associations between residents’ perceived learning behavior, experience, and demographics and their expectations with regard to teaching style and supervision levels. Methods This multicenter survey obtained data on ICU residents’ base specialty, duration of ICU training, individual postgraduate year, gender, and number of repetitions of ICU skills. Using 4-point Likert scales, residents assessed perceived learning behavior, expected teaching style, and supervision level for respective skills. Multivariate regression analysis was used to evaluate associations between assessed variables. Results Among 109 residents of four interdisciplinary ICUs, 63 (58%) participated in the survey and 95% (60/63) questionnaires were completed. The residents’ perceived learning behavior was associated with number of skill repetitions (p < 0.0001), internal medicine as base specialty (p = 0.02), and skill type (p < 0.0001). Their expected teaching style was associated with learning behavior (p < 0.0001) and skill type (p < 0.0001). Their expected supervision level was associated with skill repetitions (p < 0.0001) and skill type (p < 0.0001). Conclusion For effective learner-centered education, it appears useful to recognize how the residents’ learning behavior is affected by the number of skill repetitions and the skill type. Hence, faculty may wish to take into account the residents’ learning behavior, driven mainly by skill complexity and the number of skill repetitions, to deliver the appropriate teaching style and supervision level.

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Bronchial blocker positioning: learning curve and confidence in its use

Cited by 6 publications

References 18 publications

Airway management for one lung ventilation during COVID-19 pandemic: a survey within Italian anesthesiologists

Airway management for one lung ventilation during COVID-19 pandemic: a survey within Italian anesthesiologists

Current practice of thoracic anaesthesia in Europe – a survey by the European Society of Anaesthesiology Part I – airway management and regional anaesthesia techniques

Learner-centered education: ICU residents’ expectations of teaching style and supervision level

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