An Evaluation of a Virtual Reality Airway Simulator

In this research, we sought to test the hypothesis that the AccuTouch® Flexible Bronchoscopy Simulator (Simulator) is an effective way to teach clinicians the psychomotor skills necessary to use the fiberoptic bronchoscope as an instrument for intubating the trachea of a pediatric patient. Pediatric residents with no prior experience in fiberoptic bronchoscopy were studied. Residents performed fiberoptic intubation on children undergoing general anesthesia. Tapes of these intubations were analyzed for: time to visualization of the carina, and number and time that the bronchoscope tip hit the mucosa. Residents were then trained on the Simulator. Performance of fiberoptic intubation on a subsequent child was compared. Training on the Simulator was the only instruction that the residents received between the two cases. A control group of residents performed two consecutive intubations without training on the Simulator between cases. Residents studied an average of 17 cases, and spent 39 min on the Simulator. Performance was markedly improved after the Simulator. Time to completion of successful intubation with a bronchoscope was reduced from 5.15 to 0.88 min (P < 0.001). The number of times that the tip of the bronchoscope hit the mucosa was reduced from 21.4 to 3.0 (P < 0.001). The amount of time that the resident spent viewing the mucosa decreased from 2.24 to 0.19 min (P < 0.001). The percent of time viewing the channel of the airway increased from 58.5% to 80.4% (P = 0.004). This bronchoscopy simulator was very effective in teaching residents the psychomotor skills necessary for fiberoptic intubation. Significant improvement was seen in time to completion of endotracheal intubation, as well as other performance indicators.

[1]  H Delingette,et al.  Virtual reality applied to hepatic surgery simulation: the next revolution. , 1998, Annals of surgery.

[2]  Jonathan L. Benumof,et al.  Management of the Difficult Adult Airway With Special Emphasis on Awake Tracheal Intubation , 1991, Anesthesiology.

[3]  M. H. Dykes,et al.  Difficult pediatric intubation--an indication for the fiberoptic bronchoscope. , 1982, Anesthesiology.

[4]  J. Smith,et al.  Teaching fibreoptic nasotracheal intubation with and without closed circuit television. , 1993, British journal of anaesthesia.

[5]  W. McGaghie,et al.  Simulation technology for health care professional skills training and assessment. , 1999, JAMA.

[6]  T. Krummel.  Surgical simulation and virtual reality: the coming revolution. , 1998, Annals of surgery.

[7]  M. H. Dykes,et al.  The role of fiber-optic endoscopy in airway management , 1987 .

[8]  R. Hessler,et al.  Emergency flexible fiberoptic nasotracheal intubation: a report of 60 cases. , 1988, Annals of emergency medicine.

[9]  Richard M. Satava,et al.  Virtual reality for medical applications , 1997, Information Technology Applications in Biomedicine. ITAB '97. Proceedings of the IEEE Engineering in Medicine and Biology Society Region 8 International Conference.

[10]  M. H. Dykes,et al.  Dissemination of fibreoptic airway endoscopy skills by means of a workshop utilizing models. , 1989, British journal of anaesthesia.

[11]  A. Farmery,et al.  A model to describe the rate of oxyhaemoglobin desaturation during apnoea. , 1996, British journal of anaesthesia.

[12]  K L Posner,et al.  Adverse respiratory events in anesthesia: a closed claims analysis. , 1990, Anesthesiology.

[13]  A. Darzi,et al.  Validation of virtual reality to teach and assess psychomotor skills in laparoscopic surgery: results from randomised controlled studies using the MIST VR laparoscopic simulator. , 1998, Studies in health technology and informatics.

[14]  J. Koppel,et al.  Formal Instruction in Difficult Airway Management: A Survey of Anesthesiology Residency Programs , 1995, Anesthesiology.

[15]  A. Jackson,et al.  Learning curves for fibreoptic nasotracheal intubation when using the endoscopic video camera , 1997, Anaesthesia.

[16]  P J Hunter,et al.  Ophthalmic microsurgical robot and associated virtual environment. , 1995, Computers in biology and medicine.

[17]  C V Edmond,et al.  Virtual environments. Surgical simulation in otolaryngology. , 1998, Otolaryngologic clinics of North America.

[18]  J. Pearlman,et al.  The Development of a Multimedia Teaching Program for Fiberoptic Intubation , 1997, Journal of Clinical Monitoring.

[19]  Laparoscopic surgery. Transition to the future. , 1998, The Urologic clinics of North America.

[20]  F W Cheney,et al.  The American Society of Anesthesiologists Closed Claims Project: what have we learned, how has it affected practice, and how will it affect practice in the future? , 1999 .

[21]  Carin A. Hagberg,et al.  Practice guidelines for management of the difficult airway. A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. , 1993, Anesthesiology.