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.

Videolaryngoscopy构成了气道管理的重大进展之一 在过去的20年中。在喉镜的末端放置芯片，避免了 建立从嘴到喉的视线路径，促进声带可视化， 缩短学习曲线，并使气管插管在最小的水平上更加容易 经验。这种方式可能使使用辅助提供者（例如呼吸道）合理 55％ VA医院没有受过更高训练的麻醉人员的服务或 一直以来。由于这个系统广泛的问题，最近的VA指令强制要求Airway 这些非传统提供者的管理培训，并建议视频审理 当期望难度时，应强烈考虑插管。 但是，视频核镜检查不能保证成功的插管。解剖学 某些患者的特征使经过气管管的难以超越声带 即使对于经验丰富的麻醉师，视频核心镜也可以看出。这类 在20-30％的新兴视频镜插管中发生故障。它损害了安全 因为插管衰竭具有威胁生命的呼吸和心血管的高风险 并发症。专家可以克服视频镜镜检查难度，但是很少的操作员 在紧急情况下，经验不太可能找到适当的技术。 我们的假设是，非专家可以发展成功的技能 通过练习模拟器来进行困难患者的视频脑膜镜检查，这些努力将 提高视频镜镜检查的安全性。该项目旨在制定多个部分任务 教学培训师，教学困难的视频审理技能，制定培训计划和测试 该计划是否可以在情况下通过新手提供成功的视频插管 未经训练的操作员会失败的地方。 调查团队，包括麻醉师和工程师，已经 开发了两个配置的原型人体模型，以模拟困难的视频镜镜检查和 计划开发其他独立培训师。先前开发的仪器 系统显示喉镜，气管内管和喉部的位置， 将有助于制定动作，从而导致艰难人体模型的成功插管。 该仪器还将在培训期间向学生提供反馈。 培训计划将依靠分级练习来发展单个动作，然后 动作和成功插管的策略。这种教学技巧的方法 被称为故意实践。在培训期间，学生将从 录像专家和位置显示器的视觉反馈。训练前后 测试将提供有效性的证据。我们预计模拟培训将教导 困难的视频镜镜检查所需的特殊技能。最终目标是实现大型 提供者的人口，不仅仅是麻醉师，以提供安全的紧急气道管理 所有VA医院以及始终，夜间和白天。