Tina Heidi Pedersen

A randomised, controlled trial evaluating a low cost, 3D‐printed bronchoscopy simulator

Low‐fidelity, simulation‐based psychomotor skills training is a valuable first step in the educational approach to mastering complex procedural skills. We developed a cost‐effective bronchial tree simulator based on a human thorax computed tomography scan using rapid‐prototyping (3D‐print) technology. This randomised, single‐blind study evaluated how realistic our 3D‐printed simulator would mimic human anatomy compared with commercially available bronchial tree simulators (Laerdal® Airway Management Trainer with Bronchial Tree and AirSim Advance Bronchi, Stavanger, Norway). Thirty experienced anaesthetists and respiratory physicians used a fibreoptic bronchoscope to rate each simulator on a visual analogue scale (VAS) (0 mm = completely unrealistic anatomy, 100 mm = indistinguishable from real patient) for: localisation of the right upper lobe bronchial lumen; placement of a bronchial blocker in the left main bronchus; aspiration of fluid from the right lower lobe; and overall realism. The 3D‐printed simulator was rated most realistic for the localisation of the right upper lobe bronchial lumen (p = 0.002), but no differences were found in placement of a bronchial blocker or for aspiration of fluid (p = 0.792 and p = 0.057) compared with using the commercially available simulators. Overall, the 3D‐printed simulator was rated most realistic (p = 0.021). Given the substantially lower costs for the 3D‐printed simulator (£85 (€100/US

Transnasal humidified rapid insufflation ventilatory exchange for oxygenation of children during apnoea: a prospective randomised controlled trial.

110) compared with > ~ £2000 (€2350/US

Loss of resistance: A randomised controlled trial assessing four low-fidelity epidural puncture simulators.

2590) for the commercially available simulators), our 3D‐printed simulator provides an inexpensive alternative for learning bronchoscopy skills, and offers the possibility of practising procedures on patient‐specific models before attempting them in clinical practice.

Emergency Airway Management in a Simulation of Highly Contagious Isolated Patients: Both Isolation Strategy and Device Type Matter

Background: Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) comprises the administration of heated, humidified, and blended air/oxygen mixtures via nasal cannula at rates of ≥2 litres kg−1 min−1. The aim of this randomized controlled study was to evaluate the length of the safe apnoea time using THRIVE with two different oxygen concentrations (100% vs 30% oxygen) compared with standard low‐flow 100% oxygen administration. Methods: Sixty patients, aged 1–6 yr, weighing 10–20 kg, undergoing general anaesthesia for elective surgery, were randomly allocated to receive one of the following oxygen administration methods during apnoea: 1) low‐flow 100% oxygen at 0.2 litres kg−1 min−1; 2) THRIVE 100% oxygen at 2 litres kg−1 min−1; and 3) THRIVE 30% oxygen at 2 litres kg−1 min−1. Primary outcome was time to desaturation to 95%. Termination criteria included SpO2 decreased to 95%, transcutaneous CO2 increased to 65 mmHg, or apnoea time of 10 min. Results: The median (interquartile range) [range] apnoea time was 6.9 (5.7–7.8) [2.8–10.0] min for low‐flow 100% oxygen, 7.6 (6.2–9.1) [5.2–10.0] min for THRIVE 100% oxygen, and 3.0 (2.4–3.7) [0.2–5.3] min for THRIVE 30% oxygen. No significant difference was detected between apnoea times with low‐flow and THRIVE 100% oxygen administration (P=0.15). THRIVE with 30% oxygen demonstrated significantly shorter apnoea times (P<0.001) than both 100% oxygen modalities. The overall rate of transcutaneous CO2 increase was 0.57 (0.49–0.63) [0.29–8.92] kPa min−1 without differences between the 3 groups (P=0.25). Conclusions: High‐flow 100% oxygen (2 litres kg−1 min−1) administered via nasal cannulas did not extend the safe apnoea time for children weighing 10–20 kg compared with low‐flow nasal cannula oxygen (0.2 litres kg−1 min−1). No ventilatory effect was observed with THRIVE at 2.0 litres kg−1 min−1. Clinical trial registration: NCT02979067.

Facilitation of bronchoscopy teaching with easily accessible low-cost 3D-printing

BACKGROUND Detecting loss of resistance (LOR) can either be taught with dedicated simulators, with a cost ranging from &OV0556;1500 to 3000, or with the ‘Greengrocers Model’, requiring simply a banana. OBJECTIVES The purpose of this study was to compare three dedicated epidural puncture training simulators and a banana in their ability to simulate LOR. Our hypothesis was that there was a difference between the four simulators when comparing the detection of LOR. DESIGN Single-blinded, randomised, controlled study. SETTING Department of Anaesthesiology and Pain Therapy, Bern University Hospital, Switzerland. PARTICIPANTS Fifty-five consultant anaesthesiologists. INTERVENTIONS The participants were asked to insert an epidural catheter in four different epidural puncture training simulators: Lumbar Puncture Simulator II (Kyoto Kagaku, Kyoto, Japan), Lumbar Epidural Injection Trainer (Erler-Zimmer, Lauf, Germany), Normal Adult Lumbar Puncture/Epidural Tissue (Simulab Corp., Seattle, Washington, USA) and a banana. The simulators were placed in identical boxes to blind the participants. MAIN OUTCOME MEASURES The primary outcome was the detection of LOR rated on a 100-mm visual analogue scale, in which 0 mm represented ‘completely unrealistic’ and 100 mm represented ‘indistinguishable from a real patient’. RESULTS The mean visual analogue scale scores for LOR in the four simulators were significantly different: 60 ± 25 mm [95% confidence interval (CI), 55 to 65 mm], 50 ± 29 mm (95% CI, 44 to 55 mm), 64 ± 24 mm (95% CI, 58 to 69 mm) and 49 ± 32 mm (95% CI, 44 to 54 mm); P less than 0.001, Friedman test. CONCLUSION Two of the three dedicated epidural simulators were rated more realistic in detecting LOR than the banana, but some participants preferred the banana to the other three simulators. Given the relative cost of a banana compared with a dedicated simulator, we suggest that a banana be used to teach the technique of LOR for epidural puncture. TRIAL REGISTRATION KEK Nr: Req-2015-z087.

Self-learning Basic Life Support: A Randomised Controlled Trial on Learning Conditions

OBJECTIVE To compare 6 airway-management devices in 3 isolation scenarios regarding their effect on airway management: portable isolation unit (PIU), personal protective equipment (PPE), and standard protection measures METHODS In total, 30 anesthesiologists working in emergency medical services performed airway management on mannequins in 3 isolation settings using 6 different airway management devices (in random order): (1) standard Macintosh laryngoscope; (2) Airtraq SP-video-laryngoscope; (3) i-gel; (4) LMA-Fastrach; (5) Ambu fiberoptic-aScope; and (6) Melker cricothyrotomy-set. Each was assessed regarding time-to-ventilate (primary outcome) and rating of difficulty handling the device. RESULTS In 86% (standard protection) and 85% (PPE) of attempts, airway management was achieved in <60 seconds, irrespective of the device used. In the PIU setting, only 69% of attempts succeeded within this time frame (P<.05). Median time-to-ventilate was shorter for standard protection (23 seconds) and PPE (25 seconds) compared to the PIU (38 seconds; P<.001). In the PIU setting, the fiberscope took the longest (median, 170 seconds), while i-gel was the quickest (median, 13 seconds). The rating of difficulty (visual analogue scale [VAS], 0-100) differed significantly between the isolation scenarios: Airway management was most difficult with PIU (VAS, 76), followed by PPE (VAS, 35), and standard protection (VAS, 9) (P<.01). CONCLUSION Wearing PPE produced similar times-to-ventilate as standard protection among anesthesiologists, but it was subjectively rated more difficult. The portable isolation unit permitted acceptable times-to-ventilate when excluding fiberscope and cricothyrotomy. Supraglottic airway devices allowed the fastest airway management in all isolation scenarios, thus being highly recommendable if a portable isolation unit is used and emergency airway management becomes necessary. Infect Control Hosp Epidemiol 2018;39:145-151.