Development and validation of a virtual airway skill trainer (VAST)

描述（由申请人提供）：虚拟气道技能训练器（VAST）的开发和验证摘要“气道管理”是手术室（OR）、重症监护室（ICU）和急诊室（艾德）中最常执行的程序之一，以维持对肺部的空气供应。然而，在古老的学徒模式之外，没有标准化的课程或培训方案。因此，在住院期间很少遇到危及生命的情况，特别是与意外困难气道相关的情况（当使用传统方法无法建立气道时），限制了住院医师在诊所培训的机会。预计基于虚拟现实（VR）的培训师，具有视觉和触觉（触摸）反馈，将对气道管理培训非常重要，允许学员在受控环境中获得能力，对患者没有风险;定制学习;以及真实的时间反馈、指导和客观评估。现有的基于VR的模拟器缺乏（1）逼真的基于物理学的软组织建模;（2）由基于体内实验的模型控制的组织反应;（3）逼真的物理界面，其可以容易地改变以表示已知导致气道管理困难的患者的各种外部和相关口咽解剖结构[Cape 10]，例如，下颌后缩、软组织过多和颈围较大;（4）认知技能训练，涉及与工作负荷管理、计划、协调和基于难度水平的决策相关的高级心理功能，以及心理学（手眼协调和运动技能）技能训练;和（5）临床验证。本项目的目标是克服这些障碍，设计、开发和验证虚拟气道技能训练器（VAST）。组建了一个多学科团队，以实现以下具体目标：（SA 1）设计和开发虚拟气道技能培训器（VAST）平台。具体而言，我们将开发（1）基于体内实验研究的人体解剖学的基于物理学的计算模型;（2）用于表示临床环境的沉浸式3D高清（HD）头戴式显示器（HMD）系统（OR/ICU/艾德）;（3）创新的双带有触觉矩阵手套的手动力反馈硬件接口，允许表示与困难气道(SA 2）通过整合SA 1中生成的计算模型和实验数据，在VAST中开发气管插管（ETI）和环甲膜切开术（CCT）程序的模拟场景。VAST将包括识别错误的真实的时间反馈;指导受训者的视觉、听觉和触觉提示;并发症的生理后果显示;替代程序和器械的影响以及技能的自动真实的时间评估。(SA 3）通过在贝斯以色列女执事医疗中心（BIDMC）和波士顿的马萨诸塞州总医院（MGH）进行实验，确定VAST作为培训工具的有效性，以确保在VAST上学习适当的技能，并且在VAST上测量的表现反映了他们打算测量的技术技能。

DESCRIPTION (provided by applicant): Development and Validation of a Virtual Airway Skill Trainer (VAST) Abstract "Airway management" is one of the most frequently performed procedures in operating rooms (OR), intensive care units (ICUs) and emergency departments (ED) to maintain air supply to the lungs. Yet, there exists no standardized curriculum or training regimen outside the age-old apprenticeship model. Hence, life- threatening scenarios, particularly those associated with the unexpected difficult airway (when an airway cannot be established using traditional methods), are seldom encountered during residency, limiting the opportunity of residents to train in the clinic. It is anticipated that a virtual reality (VR)-base trainer, with visual and haptic (touch) feedback, will be invaluable for training in airway management, allowing trainees to attain competence in a controlled environment with no risk to patients; customized learning; and real time feedback, mentoring and objective assessment. Existing VR-based simulators lack (1) realistic physics-based soft tissue modeling; (2) tissue response governed by models based on in vivo experiments; (3) realistic physical interfaces which can be easily altered to represent various external, and associated oropharyngeal anatomy of a patient known to cause difficulty with airway management [CaPe10] e.g., receding jaw, excessive soft tissue and large neck circumference; (4) cognitive skill training related to higher level mental functions associated with workload management, planning, coordination, and decision-making based on level of difficulty, in addition to psychomotor (hand-eye coordination and motor skills) skill training; and (5) clinical validation. The goal of this projec is to overcome these barriers and design, develop and validate the Virtual Airway Skill Trainer (VAST). A multidisciplinary team has been assembled to achieve the following Specific Aims: (SA1) Design and develop the Virtual Airway Skill Trainer (VAST) platform. Specifically, we will develop (1) physics-based computational models of human anatomy based upon in vivo experimental studies; (2) an immersive 3D high definition (HD) head mounted display (HMD) system to represent the clinical environment (OR/ICU/ED); and (3) an innovative bi-manual force feedback hardware interface with tactile matrix gloves that allows representation of various patient anatomies associated with the difficult airway. (SA 2) Develop simulation scenarios for endotracheal intubation (ETI) and cricothyrotomy (CCT) procedures within the VAST by integrating the computational models and experimental data generated in SA1. VAST will include real time feedback identifying errors; visual, auditory and haptic cues to guide the trainee; display of physiological consequence of complications; effects of alternate procedures and devices as well as automatic real time assessment of skill. (SA 3) Establish the validity of the VAST as a training tool by conducting experiments at Beth Israel Deaconess Medical Center (BIDMC) and Massachusetts General Hospital (MGH) in Boston to ensure that appropriate skills are being learnt on the VAST and performance measured on the VAST reflect the technical skills they intend to measure.