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

摘要“气道管理”是手术室（OR）、重症监护病房（icu）和急诊科（ED）中最常执行的程序之一，以维持肺部的空气供应。然而，在古老的学徒模式之外，不存在标准化的课程或培训方案。因此，危及生命的情况，特别是那些与意外困难的气道（当气道无法使用传统方法建立时）相关的情况，在住院医师期间很少遇到，限制了住院医师在诊所接受培训的机会。基于虚拟现实（VR）的训练器，具有视觉和触觉反馈，对于气道管理培训将是非常宝贵的，允许受训者在受控环境中获得能力，而不会对患者造成风险；定制的学习;实时反馈，指导和客观评估。现有的基于vr的模拟器缺乏(1)真实的基于物理的软组织建模；(2)基于体内实验的组织反应模型；(3)真实的物理界面，可以很容易地改变，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[CaPe10]，例如，下颌后退，软组织过多和颈部周长；(4)在精神运动（手眼协调和运动技能）技能训练的基础上，进行与工作量管理、计划、协调和基于难度水平的决策相关的高级心理功能的认知技能训练；(5)临床验证。该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：（SA1）设计和开发虚拟气道技能训练器（VAST）平台。具体来说，我们将开发(1)基于体内实验研究的基于物理的人体解剖学计算模型；(2)一个沉浸式3D高清头戴式显示器（HMD）系统，代表临床环境（OR/ICU/ED）；(3)一种创新的双手力反馈硬件接口，带有触觉矩阵手套，可以表示与困难气道相关的各种患者解剖结构。（sa2）通过整合SA1中生成的计算模型和实验数据，在VAST中开发气管插管（ETI）和环甲环切开术（CCT）程序的模拟场景。VAST将包括识别错误的实时反馈；视觉、听觉和触觉提示指导受训者；显示并发症的生理后果；替代程序和设备的影响以及技能的自动实时评估。（SA 3）通过在Beth Israel Deaconess医疗中心（BIDMC）和波士顿马萨诸塞州总医院（MGH）进行实验，确定VAST作为培训工具的有效性，以确保通过VAST学习适当的技能，并且在VAST上测量的绩效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.