Simulation Training for Critical Care Airway Management

Shah, Ronak; Makaryus, Mina; Kumar, Rohit; Singas, Effie; Mayo, Paul H.

doi:10.1016/j.chest.2020.01.047

Cited by 8 publications

(2 citation statements)

References 30 publications

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“…However, the interval hypotheses testing procedure is general and applicable to all domains where the similarity of two methods should be addressed, for example, to judge the performance of two diagnostic medical devices [ 35 ]. Indeed, also in the medical literature, researchers started using TOST to compare the outcomes of different machines [ 36 , 37 , 38 ].…”

Section: Methodsmentioning

confidence: 99%

Technical aspects and validation of custom digital algorithms for hand volumetry

Nascimben

Lippi

Fusco

et al. 2023

THC

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BACKGROUND: Establishing baseline measurements on normative data is essential to evaluate standards of care and the impact of clinical or surgical treatments. Hand volume determination is relevant in pathological conditions where the anatomical structures might undergo modifications like post-treatment chronic edema. For example, one of the consequences of breast cancer treatment is the possibility of developing uni-lateral lymphedema on the upper limbs. OBJECTIVE: Arm and forearm volumetrics are well-studied techniques, whereas hand volumetry computation poses several challenges both from the clinical and digital perspectives. The current work has explored routine clinical and customized digital methodologies for hand volume appraisal on healthy subjects. METHODS: Clinical hand volumes computed by water displacement or circumferential measurements were compared to digital volumetry calculated from 3D laser scans. Digital volume quantification algorithms exploited the gift wrapping concept or cubic tessellation of acquired 3D shapes. This latter digital technique is parametric, and a calibration methodology to define the resolution of the tessellation has been validated. RESULTS: Results on a group of normal subjects demonstrated that the volumes computed from digital hand representations extracted by tessellation return values similar to the clinical water displacement volume assessment at low tolerances. CONCLUSIONS: The current investigation suggested that the tessellation algorithm could be considered a digital equivalent of water displacement for hand volumetrics. Future studies are needed to confirm these results in people with lymphedema.

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Section: Methodsmentioning

confidence: 99%

Technical aspects and validation of custom digital algorithms for hand volumetry

Nascimben

Lippi

Fusco

et al. 2023

THC

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“…Bronchoscopic imaging provides trainees with useful data for minimizing injuries and dangerous sharp instrument technique. Several recent studies have shown utility in using video monitoring during simulation trainings to assess quality of simulation, complications, and formative skill testing [33][34][35]. Endoscopy has been shown to be accurate in detecting posterior tracheal wall injuries caused by kit cricothyrotomies as confirmed by cadaveric dissection [24].…”

Section: Plos Onementioning

confidence: 99%

Cadaveric emergency cricothyrotomy training for non-surgeons using a bronchoscopy-enhanced curriculum

et al. 2023

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Background Emergency cricothyrotomy training for non-surgeons is important as rare “cannot intubate or oxygenate events” may occur multiple times in a provider’s career when surgical expertise is not immediately available. However, such training is highly variable and often infrequent, therefore, enhancing these experiences is important. Research question Is bronchoscopy-enhanced cricothyrotomy training in cadavers feasible, and what are the potential benefits provided by this innovation for trainees? Methods This study was performed during implementation of a new program to train non-surgeon providers on cadaveric donors on our campus. Standard training with an instructional video and live coaching was enhanced by bronchoscopic visualization of the trachea allowing participants to review their technique after performing scalpel and Seldinger-technique procedures, and to review their colleagues’ technique on live video. Feasibility was measured through assessing helpfulness for trainees, cost, setup time, quality of images, and operator needs. Footage from the bronchoscopy recordings was analyzed to assess puncture-to-tube time, safety errors, and evidence for a training effect within groups. Participants submitted pre- and post-session surveys assessing their levels of experience and gauging their confidence and anxiety with cricothyrotomies. Results The training program met feasibility criteria for low costs (<200 USD/donor), setup time (<30 minutes/donor), and operator needs (1/donor). Furthermore, all participants rated the cadaveric session as helpful. Participants demonstrated efficient technique, with a median puncture-to-tube time of 48.5 seconds. Bronchoscopy recordings from 24 analyzed videos revealed eight instances of sharp instruments puncturing the posterior tracheal wall (33% rate), and two instances of improper tube placement (8% rate). Sharp instruments reached potentially dangerous insertion depths beyond the midpoint of the anterior-posterior diameter of the trachea in 58.3% of videos. Bronchoscopic enhancement was rated as quite or extremely helpful for visualizing the trachea (83.3%) and to assess depth of instrumentation (91.7%). There was a significant average increase in confidence (64.4%, P<0.001) and average decrease in performance anxiety (-11.6%, P = 0.0328) after the session. A training effect was seem wherein the last trainee in each group had no posterior tracheal wall injuries. Interpretation Supplementing cadaveric emergent cricothyrotomy training programs with tracheal bronchoscopy is feasible, helpful to trainees, and meets prior documented times for efficient technique. Furthermore, it was successful in detecting technical errors that would have been missed in a standard training program. Bronchoscopic enhancement is a valuable addition to cricothyrotomy cadaveric training programs and may help avoid real-life complications.

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The Anesthesiologist’s Role in Teaching Airway Management to Nonanesthesiologists

Grissom

Samet

2020

Advances in Anesthesia

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Simulation Training for Critical Care Airway Management

Cited by 8 publications

References 30 publications

Technical aspects and validation of custom digital algorithms for hand volumetry

Technical aspects and validation of custom digital algorithms for hand volumetry

Cadaveric emergency cricothyrotomy training for non-surgeons using a bronchoscopy-enhanced curriculum

The Anesthesiologist’s Role in Teaching Airway Management to Nonanesthesiologists

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