Mastery of Videolaryngoscopy through Deliberate Practice

通过刻意练习掌握视频喉镜

• 批准号: 8669614
• 负责人: RANDOLPH H HASTINGS
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8669614
• 关键词: Algorithms; Anatomy; Anesthesia procedures; Anesthesiology; Cardiovascular system; Caring; Cessation of life; Characteristics; Collaborations; Critical Illness; Educational process of instructing; Effectiveness; Emergency Department Physician; Emergency Situation; Engineering; Ensure; Environmental air flow; Exercise; Failure; Feedback; Goals; Height; Hospitals; Hour; Human Resources; Imagery; Individual; Injury; Intratracheal Intubation; Intubation; Laryngoscopes; Laryngoscopy; Larynx; Lead; Learning; Life; Location; Manikins; Mechanics; Methods; Modality; Modeling; Motion; Operating Rooms; Oral; Oral cavity; Oxygen; Patients; Performance; Population; Positioning Attribute; Problem Solving; Procedures; Provider; Research; Research Personnel; Safety; Services; Simulate; Site; Solutions; Students; System; Systems Analysis; Techniques; Testing; Time; Tongue; Trainers Training; Training; Training Programs; Tube; United States Department of Veterans Affairs; Vision; Work; base; design; endotracheal; experience; falls; high risk; improved; instrumentation; programs; prototype; respiratory; simulation; skills; skills training; success; tool; trend; visual feedback; vocal cord

Videolaryngoscopy constitutes one of the significant advances in airway management over the last 20 years. Placing a chip at the end of the laryngoscope obviates the need to establish a line of sight path from the mouth to larynx, facilitates vocal cord visualization, shortens learning curves and makes endotracheal intubation easier at minimal levels of experience. The modality may make it rational to use ancillary providers such as respiratory therapists, medics or non-anesthetist physicians for emergency airway management in the 55% of VA hospitals that do not have service from more highly trained anesthesia personnel part or all of the time. Because of this system wide problem, a recent VA directive mandated airway management training for these non-traditional providers and suggested that videolaryngoscopy should be strongly considered for intubation when difficulty is expected. Videolaryngoscopy does not guarantee successful intubation, however. Anatomic characteristics in some patients make it difficult to pass the endotracheal tube past vocal cords that are in plain view with a videolaryngoscope, even for experienced anesthetists. This type of failure occurs in 20-30% of emergent videolaryngoscopy intubations. It compromises safety because failed intubations have a high risk of life-threatening respiratory and cardiovascular complications. Experts can overcome videolaryngoscopy difficulty, but an operator with minimal experience would be unlikely to find the appropriate techniques in an emergency. Our hypothesis is that non-experts can develop the skills for successful videolaryngoscopy in difficult patients by practicing on simulators and that these efforts will improve the safety of videolaryngoscopy. The project aims to produce multiple partial task trainers for teaching difficult videolaryngoscopy skills, develop a training program and test whether the program enables successful video intubation by novice providers in situations where an untrained operator would fail. The investigative team, including anesthesiologists and engineers, has already developed two prototype mannequins configured to simulate difficult videolaryngoscopy and plans to develop additional independent trainers. A previously developed instrumentation system, which display the positions of laryngoscope, endotracheal tube and larynx in real time, will assist in devising maneuvers that lead to successful intubation in the difficult mannequins. This instrumentation will also provide feedback to students during training. The training program will rely on graded exercises to develop individual motions, then maneuvers and strategies for successful intubation. This approach to teaching procedural skills is called deliberate practice. During the training, students will receive oral feedback from videolaryngoscopy experts and visual feedback from the position display. Pre- and post-training tests will provide evidence for effectiveness. We anticipate that simulation training will teach the special skills needed for difficult videolaryngoscopy. The ultimate objective is to enable a large population of providers, not just anesthetists, to provide safe emergency airway management in all VA hospitals and at all times, night and day.

视频喉镜是气道管理的重大进步之一 过去20年。将芯片放置在喉镜末端，无需 建立从口腔到喉部的视线路径，促进声带可视化， 缩短学习曲线，使气管插管在最低水平下变得更容易 经验。该模式可能使使用辅助提供者（例如呼吸系统）变得合理。 55% 的患者由治疗师、医务人员或非麻醉医师进行紧急气道管理 没有训练有素的麻醉人员提供服务的 VA 医院的一部分或 一直。由于这个系统范围内的问题，最近的 VA 指令强制要求气道 对这些非传统提供者进行管理培训，并建议视频喉镜 当预计有困难时，应强烈考虑插管。 然而，视频喉镜并不能保证插管成功。解剖学 某些患者的特征导致气管插管难以通过声带 即使对于经验丰富的麻醉师来说，通过视频喉镜也可以清楚地看到这些内容。这类 20-30% 的紧急视频喉镜插管发生失败。它会危及安全 因为插管失败​​有很高的危及生命的呼吸系统和心血管疾病的风险 并发症。专家可以克服视频喉镜检查的困难，但操作者只需极少的努力 经验不可能在紧急情况下找到适当的技术。 我们的假设是非专家也可以培养成功的技能 通过在模拟器上练习对困难患者进行视频喉镜检查，这些努力将 提高视频喉镜的安全性。该项目旨在产生多个部分任务 培训师教授困难的视频喉镜技能，制定培训计划和测试 该程序是否能够让新手在某些情况下成功进行视频插管 未经培训的操作员可能会失败。 包括麻醉师和工程师在内的调查小组已经 开发了两个原型人体模型，用于模拟困难的视频喉镜检查 计划培养更多的独立培训师。先前开发的仪器 系统，实时显示喉镜、气管插管、喉部位置， 将协助设计能够在困难的人体模型中成功插管的操作。 该仪器还将在培训期间向学生提供反馈。 训练计划将依靠分级练习来发展个人动作，然后 成功插管的操作和策略。这种教授程序技能的方法 称为刻意练习。培训期间，学员将收到口头反馈 视频喉镜专家的位置显示和视觉反馈。训练前和训练后 测试将为有效性提供证据。我们预计模拟培训将教授 困难的视频喉镜检查需要特殊技能。最终目标是实现大 提供安全紧急气道管理的医疗服务人员，而不仅仅是麻醉师 所有退伍军人管理局医院，无论白天还是黑夜。