Learning Curves for Bag-and-mask Ventilation and Orotracheal Intubation An Application of the Cumulative Sum Method
Learning Curves for Bag-and-mask Ventilation and Orotracheal Intubation An Application of the Cumulative Sum Method
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DOI：
10.1097/aln.0b013e3181d96779
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发表时间：
2010-06-01
期刊：
影响因子：
8.8
通讯作者：
Ozaki, Makoto
中科院分区：
文献类型：
--
作者：
Komatsu, Ryu;Kasuya, Yusuke;Ozaki, Makoto
背景资料：在这项研究中，作者确定了实习生学习袋和面罩通气和经口气管插管的成功率和失败率。他们的目标是确定正确执行这些手术所需的经验量。方法：作者记录了15名经验不足的实习生在为期3个月的麻醉轮换期间进行的695次袋罩通气和679次经口气管插管。每个实习生的每个程序的学习曲线都是用标准和风险调整累积和方法构建的。估计为每个technique.Results：14的15名实习生达到可接受的失败率在袋和面罩通气后27 +/- 13程序，中位数（95%的置信区间）为25（15-32）程序时，考虑到所有15名实习生越过决策限制。在26 +/- 8次手术后，15名实习生中有9名在经口气管插管时达到了可接受的失败率，当考虑所有实习生时，中位数为29次（22次-无法估计）手术。面罩通气失败率可接受的实习生比例高于气管插管（93% vs. 60%，P = 0.025）。总的来说，我们的实习生达到了袋和面罩通气失败率为20%或更好的中位数后25个程序，约80%的实习生实现了目标后35个程序或less.Conclusions：参与实习生开发面罩通气技能比经口气管插管技能更快，有更多的变化率插管技能的发展。平均需要29次手术才能达到80%的经口气管插管成功率。
Background: In this study, the authors determined the success and failure rates for interns learning bag-and-mask ventilation and orotracheal intubation. Their goal was to determine the amount of experience needed to perform these procedures correctly.Methods: The authors recorded 695 bag-and-mask ventilations and 679 orotracheal intubations performed by 15 inexperienced interns during their 3 month-long anesthesia rotations. Learning curves for each procedure for each intern were constructed with both the standard and risk-adjusted cumulative sum methods. The average number of procedures required to attain a failure rate of 20% was estimated for each technique.Results: Fourteen of 15 interns attained acceptable failure rates at bag-and-mask ventilation after 27 +/- 13 procedures, with a median (95% confidence interval) of 25 (15-32) procedures to cross the decision limit when considering all 15 interns. Nine of 15 interns attained acceptable failure rates at orotracheal intubation after 26 +/- 8 procedures, with a median of 29 (22-not estimable) procedures to cross the limit when considering all interns. The proportion of interns who attained acceptable failure rates for mask ventilation was greater than for tracheal intubation (93% vs. 60%, P = 0.025). Overall, our interns achieved a bag-and-mask ventilation failure rate of 20% or better after a median of 25 procedures; approximately 80% of interns achieved the goal after 35 procedures or less.Conclusions: Participating interns developed mask ventilation skills faster than orotracheal intubation skills, and there was more variability in the rate at which intubation skills developed. A median of 29 procedures was required to achieve an 80% orotracheal intubation success rate.