Mastery of Videolaryngoscopy through Deliberate Practice

电视喉镜检查是呼吸道管理的重大进步之一 在过去的20年里。在喉镜的末端放置芯片不需要 建立从口到喉的视线路径，便于声带可视化， 缩短学习曲线，并使气管插管更容易在最低水平 经验。这种方式可能会使使用辅助提供者(如呼吸道)变得合理 在55%的患者中，治疗师、医生或非麻醉师医生进行了紧急呼吸道管理 没有更多训练有素的麻醉人员提供服务的退伍军人医院的部分或 一直都是。由于这个系统范围的问题，最近退伍军人事务部的一项指令强制要求航空公司 为这些非传统提供商提供管理培训，并建议视频喉镜检查 当预计会有困难时，应强烈考虑插管。 然而，电视喉镜检查并不能保证插管成功。解剖学 某些患者的特点使气管插管很难通过声带 即使对于有经验的麻醉师来说，视频喉镜也能清楚地看到这些情况。这种类型的 20%-30%的紧急视频喉镜插管失败。它损害了安全 因为插管失败的风险很高，会危及呼吸和心血管系统的生命。 并发症。专家可以克服视频喉镜检查的困难，但操作员需要最低限度的 经验不太可能在紧急情况下找到合适的技术。 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对疑难患者进行视频喉镜检查，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 培训讲授困难的视频咽喉镜技术，制定培训计划和测试 该程序是否支持新手提供商在以下情况下成功进行视频插管 一个未受过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，配置为模拟困难的视频喉镜检查和 计划开发更多的独立教官。以前开发的一种仪器 实时显示喉镜、气管插管和喉部位置的系统， 将协助设计能够在困难的人体模型上成功插管的动作。 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，然后 成功插管的操作和策略。这种讲授程序技能的方法 被称为刻意练习。在培训期间，学员将收到来自 视频喉镜专家和来自位置的视觉反馈显示。培训前和培训后 测试将提供有效性的证据。我们预计模拟训练将教会 困难的视频喉镜检查所需的特殊技能。最终目标是使大型 提供安全的紧急呼吸道管理的提供者群体，而不仅仅是麻醉师 所有退伍军人医院，不分昼夜。

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.