Mastery of Videolaryngoscopy through Deliberate Practice

电视喉镜是气道管理的重要进展之一 在过去的20年里。在喉镜末端放置芯片， 建立从嘴到喉的视线路径，促进声带可视化， 缩短学习曲线，使气管插管更容易， 体验.该模式可能使使用辅助提供者（如呼吸系统）变得合理 55%的患者由治疗师、内科医生或非麻醉医师进行紧急气道管理 没有受过更高培训的麻醉人员提供服务的VA医院的一部分， 一直都是由于这个系统范围的问题，最近的VA指令要求气道 对这些非传统提供者进行管理培训，并建议视频喉镜检查 当预期有困难时，应强烈考虑插管。 然而，电视喉镜检查并不能保证插管成功。解剖 一些患者的特征使得气管内导管难以通过声带 即使是经验丰富的麻醉师也可以通过视频喉镜清晰地看到。这种类型的 20-30%的紧急视频喉镜插管失败。这会危及安全 因为失败的插管有很高的危及生命的呼吸和心血管风险， 并发症专家们可以克服视频喉镜检查的困难，但操作员 经验不可能在紧急情况下找到适当的技术。 我们的假设是，非专家可以发展成功的技能， 通过在模拟器上练习，在困难患者中使用视频喉镜，这些努力将 提高电视喉镜检查的安全性。该项目旨在产生多个部分任务 培训师教授困难的视频喉镜检查技能，制定培训计划并进行测试 该计划是否能够使新手提供者在以下情况下成功进行视频插管 未经训练的操作员会失败。 包括麻醉师和工程师在内的调查小组已经 开发了两个原型人体模型，用于模拟困难的视频喉镜检查， 计划培养更多的独立培训师。以前开发的仪器 系统真实的实时显示喉镜、气管导管和喉的位置， 将有助于设计操作，导致在困难的人体模型成功插管。 该仪器还将在培训期间向学生提供反馈。 训练计划将依靠分级练习来发展个人动作， 成功插管的技巧和策略。这种教授程序技能的方法 叫做刻意练习在培训期间，学生将收到来自 视频喉镜检查专家和来自位置显示器的视觉反馈。培训前后 测试将提供有效性的证据。我们预计，模拟训练将教 需要特殊技能的困难视频喉镜检查。最终目标是使一个大的 提供者的人口，而不仅仅是麻醉师，提供安全的紧急气道管理， 所有退伍军人管理局的医院，无论白天黑夜

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.