Neonatal Endotracheal Intubation: Enhancing Training Through Computer Simulation and Automated Evaluation

项目摘要 新生儿气管内插管（ETI）是一个时间敏感的复苏程序！对于通风至关重要， 新生儿由于气道狭窄、舌头相对较大、前部，它需要异常高的技能水平 声门位置和新生儿的低呼吸储备（Bercic，Pocajt等，1978）。考虑到 手术和高并发症发生率在未经训练的手，有效的培训是至关重要的。然而，在这方面， 根据目前的复苏培训计划，儿科住院医师的插管成功率很低， 住院1-3年之间几乎没有改善（23-25%）（奥唐纳，Kamlin等人，2006年; Haubner，巴里等人，2006年） al. 2013年）。迫切需要了解导致培训效果不佳的因素， 创新的培训模式，可以弥合传统培训留下的差距，从而使快速技能 采集 我们假设，目前的培训和评估方法存在4个关键弱点：（1）差 真实感：基于人体模型和模拟器的训练通常在解剖结构或难度级别上几乎没有变化 （Dreyfus，Athanasiou等人，1986年）-并且没有现实地模拟 真实的组织的外观、感觉和运动。(2)主观、高度可变和资源密集型评估 方法：培训机会因缺乏专家教员而受到限制。(3)可视化差： 学习者对哪里出了问题以及如何改进知之甚少;他们无法确切地看到 在人体模型或患者体内进行，并且不能直接监测他们相对于理想化的、专家的动作。 性能(4)人工理想条件下的评价：ETI课堂表现的评价 设置可能会高估受训者的技能水平，因为他们没有模仿压力源和分心， 是真实的临床环境中固有的。 技术增强的ETI模拟器可以解决所有这些关键弱点： 增强现实（AR）的初步工作（Hahn，Li等人。2016; Soghier，Li等人。2014）（Azuma 1997） 由受训者和物理人体模型的运动实时驱动的人体模型模拟器，1）提供 ETI技术的定量评估和2）允许受训者可视化喉镜的运动 在人体模型里评估分数可以在执行过程中提供反馈，并构成 这是对受训者技能评估的一部分。本提案下的工作将以这一初步工作为基础。的 具体目标是：将当前的增强现实（AR）人体模型模拟器扩展到虚拟现实（VR） 计算机模拟器和验证，扩展和验证自动评估和可视化算法， ETI，通过测试3年内儿科住院医师组来研究培训有效性， 在插管性能方面， 模拟器和患者的临床结果，并在更现实的条件下评估性能。

Project Summary Neonatal endotracheal intubation (ETI) is a time-sensitive resuscitation procedure! essential for ventilation of newborns. It requires an unusually high level of skill due to the narrow airways, relatively large tongue, anterior glottic position, and low respiratory reserve of neonates (Bercic, Pocajt et al. 1978). Given the difficulty of the procedure and the high rate of complications in untrained hands, effective training is crucial. However, intubation success rates for pediatric residents are low under current resuscitation training programs and show little improvement between years 1-3 of residency (23-25%) (O'Donnell, Kamlin et al. 2006; Haubner, Barry et al. 2013). There is a pressing need to understand the factors that lead to poor training results and for innovative training modalities that can bridge the gap left by traditional training and thereby allow rapid skill acquisition. We hypothesize that current training and assessment methods suffer from 4 key weaknesses: (1) Poor realism: manikin and simulator-based training typically provide little variation in anatomy or difficulty level—key requirements for developing expertise (Dreyfus, Athanasiou et al. 1986)—and do not realistically model the look, feel, and motions of real tissue. (2) Subjective, highly variable, and resource-intensive assessment methods: training opportunities are limited by the availability of expert instructors. (3) Poor visualization: learners have poor knowledge about what went wrong and how to improve; they cannot see exactly what is going on inside the manikin or the patient and cannot directly monitor their actions relative to idealized, expert performance. (4) Assessment under artificially ideal conditions: assessments of ETI performance in classroom settings likely overestimate trainees' skill level because they do not mimic the stressors and distractions that are inherent in the real clinical environment. Technology-enhanced ETI simulators can resolve all of these key weaknesses: We have conducted preliminary work (Hahn, Li et al. 2016; Soghier, Li et al. 2014) on an augmented reality (AR (Azuma 1997)) manikin simulator driven by the motions of the trainee and physical manikin in real time that 1) provides a quantitative assessment of ETI technique and 2) allows the trainee to visualize the motion of the laryngoscope inside the manikin. The assessment score can provide feedback during the performance, as well as constitute part of the evaluation of the trainee's skill. Work under this proposal will build on this preliminary work. The specific aims are to: extend the current augmented reality (AR) manikin simulator to a virtual reality (VR) computer simulator and validate, extend and validate automated assessment and visualization algorithm for ETI, study training effectiveness by testing groups of pediatric residents across 3 years to quantify the effect of technology-enhanced methods relative to the current training regimen in terms of both intubation performance on simulators and clinical outcomes in patients, and assess performance under more realistic conditions.