Comparison of the force applied on oral structures during intubation attempts by novice physicians between the Macintosh direct laryngoscope, Airway Scope and C-MAC PM: a high-fidelity simulator-based study

Nakanishi, Taizo; Shiga, Takashi; Homma, Yosuke; Koyama, Yoshinori; Goto, Tadahiro

doi:10.1136/bmjopen-2016-011039

Cited by 17 publications

(24 citation statements)

References 23 publications

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“…We prospectively collected and analyzed data from the Japanese Airway Management Quantification (JAMQ) study. The JAMQ study is a prospective multi-center data registry developed to investigate factors associated with the improvement of intubation skills among post-graduate year-1 (PGY-1) physicians using a high-fidelity simulator, with all data collection planned a priori [ 10 – 12 ]. The JAMQ study was initiated in April 2015 as a consortium of two academic hospitals (University of Fukui Hospital and University of Tsukuba Hospital), and two community medical centers (Fukui Prefectural Hospital and Tokyo Bay Urayasu/Ichikawa Medical Center), from different geographic regions across Japan.…”

Section: Methodsmentioning

confidence: 99%

“…We used a high-fidelity airway management simulator, Waseda Kyoto Airway No.5 (Kyoto-Kagaku, Kyoto, Japan), to quantify each participant’s intubation skills [ 10 – 12 ]. Implanted sensors in the simulator automatically quantified the force applied on the maxillary incisors and the tongue during an intubation attempt [ 10 , 11 ]. We defined a ‘normal airway scenario’ as a scenario with a mouth opening to 4.5 cm.…”

Section: Methodsmentioning

confidence: 99%

“…The reasons of the scarce data include the difficulty of quantification of the force on oral structures and potential harm of on-site assessment of intubation skills in the clinical settings. Nevertheless, recent newly developed high-fidelity simulators with assessment systems enabled us to quantify the force applied on oral structures [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal acquisition of endotracheal intubation skills in novice physicians

et al. 2017

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Little is known about the acquisition of intubation skills among novice physicians during their one-year clinical training. Our primary objective was to determine the changes in the intubation skills of novice physicians between prior to the clinical training and after completion of the clinical training. We used data of a prospective longitudinal multicenter data registry developed to investigate factors associated with the improvement of intubation skills among novice physicians. The study participants included 90 postgraduate year 1 physicians in 2015–2016. We used 4 simulation scenarios based on the devices used (direct laryngoscope [DL] and Airway scope [AWS]) and difficulty of intubation (normal and difficult scenarios). As a marker of the intubation skills, we used the force applied on the maxillary incisors and the tongue with each intubation. We compared the data obtained prior to clinical training with those obtained after completion of one-year clinical training. When using DL, compared to prior, significantly less force were applied on the maxillary incisors and the tongue after clinical training in the normal scenario (28.0 N vs 19.5 N, p < 0.001, and 11.1 N vs 8.4 N, p = 0.004). Likewise, when using AWS, compared to prior, significantly less force were applied on the tongue after clinical training in the normal scenario (22.0 N vs 0 N, p < 0.001). The force on the tongue decreased after clinical training but not significant. These associations persisted in the difficult airway scenario. These findings suggest that force applied on oral structures can be quantified as a marker of intubation skills by using high-fidelity simulators, and the assessment of procedural competency is recommended for all novice physicians prior to performing intubation in the clinical setting to improve the quality of emergency care.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Longitudinal acquisition of endotracheal intubation skills in novice physicians

et al. 2017

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“…More specifically, compared to DL use, VL use is associated with a better laryngeal visualization, higher first‐pass success rate, shorter time to successful intubation, and lower rate of intubation‐related adverse events (e.g., esophageal intubation) in general ED patients, and patients with trauma, difficult airway, and cardiac arrest . Furthermore, the use of VL is also associated with a lower force to oral structures regardless of the experience of the intubator . In Japan, the rate of VL use on the first intubation attempt has increased from 2% in 2010 to 40% in 2016 …”

Section: Devicesmentioning

confidence: 99%

Advancing emergency airway management practice and research

Goto

Hagiwara

et al. 2019

Acute Medicine & Surgery

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Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.

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“…The realization of this device was conducted starting from robotic prototypes, which underwent clinical validation [15]. In a recent study by Nakanishi et al [16], this device was used to compare different performances by novel physicians with direct laryngoscope and video-laryngoscope. They evidence how video-laryngoscope guarantees a lower pressure on tongue during intubation; on the other hand, in contrast with other studies [17] on adult patients, they find a higher pressure on dental arches during video-laryngoscope intubation, probably due to the lack of clinical experience of their participants.…”

Section: Discussionmentioning

confidence: 99%

Technical realization of a sensorized neonatal intubation skill trainer for operators’ retraining and a pilot study for its validation

et al. 2018

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BackgroundIn neonatal endotracheal intubation, excessive pressure on soft tissues during laryngoscopy can determine permanent injury. Low-fidelity skill trainers do not give valid feedback about this issue. This study describes the technical realization and validation of an active neonatal intubation skill trainer providing objective feedback.MethodsWe studied expert health professionals’ performances in neonatal intubation, underlining chance for procedure retraining. We identified the most critical points in epiglottis and dental arches and fixed commercial force sensors on chosen points on a ©Laerdal Neonatal Intubation Trainer. Our skill trainer was set up as a grade 3 on Cormack and Lehane’s scale, i.e. a model of difficult intubation. An associated software provided real time sound feedback if pressure during laryngoscopy exceeded an established threshold. Pressure data were recorded in a database, for subsequent analysis with non-parametric statistical tests. We organized our study in two intubation sessions (5 attempts each one) for everyone of our participants, held 24 h apart. Between the two sessions, a debriefing phase took place. In addition, we gave our participants two interview, one at the beginning and one at the end of the study, to get information about our subjects and to have feedback about our design.ResultsWe obtained statistical significant differences between consecutive attempts, with evidence of learning trends. Pressure on critical points was significantly lower during the second session (p < 0.0001). Epiglottis’ sensor was the most stressed (p < 0.000001). We found a significant correlation between time spent for each attempt and pressures applied to the airways in the two sessions, more significant in the second one (shorter attempts with less pressure, rs = 0.603).ConclusionsOur skill trainer represents a reliable model of difficult intubation. Our results show its potential to optimize procedures related to the control of trauma risk and to improve personnel retraining.Electronic supplementary materialThe online version of this article (10.1186/s13052-017-0435-z) contains supplementary material, which is available to authorized users.

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Comparison of the force applied on oral structures during intubation attempts by novice physicians between the Macintosh direct laryngoscope, Airway Scope and C-MAC PM: a high-fidelity simulator-based study

Cited by 17 publications

References 23 publications

Longitudinal acquisition of endotracheal intubation skills in novice physicians

Longitudinal acquisition of endotracheal intubation skills in novice physicians

Advancing emergency airway management practice and research

Technical realization of a sensorized neonatal intubation skill trainer for operators’ retraining and a pilot study for its validation

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