endotracheal simulation

OBJECTIVE: Airway management is a cornerstone of helicopter air ambulance patient management. The purpose of this study was to evaluate the overall quality of airway management of critical care crews in 3 common locations for intubation. METHODS: This was a prospective observational simulation study assessing the overall airway management of critical care providers managing simulated patients in an emergency department, helicopter, and ambulance. Composite scores were obtained and compared with respect to physical environment and provider certification level...

AIM: Respiratory distress syndrome often necessitates endotracheal surfactant administration in extremely preterm infants. Our study aimed to explore a multi-modal simulation tool for investigating treatment strategies in ex vivo sheep lungs during spontaneous breathing. METHODS: An electromechanical lung simulator (xPULM) mimicking spontaneous breathing was coupled with a non-aerated premature sheep lung, replicating a premature respiratory system. Changes in tidal volume for different positive end-expiratory pressure (PEEP) levels prior to and after either bolus or nebulised surfactant administration were compared...

RATIONALE: The high resistance of pediatric endotracheal tubes (ETTs) exposes mechanically ventilated children to a particular risk of developing intrinsic positive end-expiratory pressure (iPEEP). To date, determining iPEEP at the bedside requires the execution of special maneuvers, interruption of ventilation, or additional invasive measurements. Outside such interventions, iPEEP may be unrecognized. OBJECTIVE: To develop a new approach for continuous calculation of iPEEP based on routinely measured end-expiratory flow and ETT resistance...

BACKGROUND: The progress of interventional respiratory medicine necessitates a comprehensive knowledge of the segmental bronchi because of their complexity in branching patterns. Therefore, based on extensive research data, we aimed to examine the anatomical diversity and sex-related variations of the segmental bronchial branching patterns in the bilateral inferior lobes. METHODS: Following the exclusion and inclusion criteria, a total of 10,000 participants who underwent multi-slice computed tomography (MSCT) scans from September 2019 to December 2021 at Cheeloo College of Medicine, Shandong University were enrolled in this retrospective study...

AIM: We developed an augmented reality technology-based endotracheal aspiration simulation tool (the AR tool) consisting of three modes: a mode for nursing students to learn endotracheal aspiration by themselves (learning mode); a mode for repeated practice (practice mode); and a mode for confirmation testing (test mode). This study aimed to compare the learning outcomes of the AR tool with traditional training mannequins and identify potential uses and improvements of the AR tool. METHODS: We invited students, and faculty members from the three universities who agreed to cooperate in conducting this study...

BACKGROUND: More than 90% of pediatric patients presenting to emergency departments (EDs) in the United States are evaluated and treated in community-based EDs. Recent evidence suggests that mortality outcomes may be worse for critically ill pediatric patients treated at community EDs. The disparate mortality outcomes may be due to inconsistency in pediatric-specific education provided to emergency medicine (EM) trainees during residency training. There are few studies surveying recently graduated EM physicians assessing perceived gaps in the pediatric emergency medicine (PEM) education they received during residency...

OBJECTIVE: The risk of occupational exposure during endotracheal intubation has required the global Emergency Medicine (EM), Anesthesia, and Critical Care communities to institute new COVID- protected intubation guidelines, checklists, and protocols. This survey aimed to deepen the understanding of the changes in intubation practices across Canada by evaluating the pre-COVID-19, early-COVID-19, and present-day periods, elucidating facilitators and barriers to implementation, and understanding provider impressions of the effectiveness and safety of the changes made...

Objective: In emergency medicine, airway management is a core skill that includes endotracheal intubation (ETI), a common technique that can result in ineffective ventilation and laryngotracheal injury if executed incorrectly. We present a method for automatically generating performance feedback during ETI simulator training, potentially augmenting training outcomes on robotic simulators. Method: Electret microphones recorded ultrasonic echoes pulsed through the complex geometry of a simulated airway during ETI performed on a full-size patient simulator...

INTRODUCTION: During mechanical ventilation, cyclic recruitment and derecruitment (R/D) of alveoli result in focal points of heterogeneous stress throughout the lung. In the acutely injured lung, the rates at which alveoli can be recruited or derecruited may also be altered, requiring longer times at higher pressure levels to be recruited during inspiration, but shorter times at lower pressure levels to minimize collapse during exhalation. In this study, we used a computational model to simulate the effects of airway pressure release ventilation (APRV) on acinar recruitment, with varying inspiratory pressure levels and durations of exhalation...

BACKGROUND: Tracheobronchial mucus plays a crucial role in pulmonary function by providing protection against inhaled pathogens. Due to its composition of water, mucins, and other biomolecules, it has a complex viscoelastic rheological behavior. This interplay of both viscous and elastic properties has not been fully described yet. In this study, we characterize the rheology of human mucus using oscillatory and transient tests. Based on the transient tests, we describe the material behavior of mucus under stress and strain loading by mathematical models...

OBJECTIVE: To compare the endotracheal intubation skill retention of the McGRATH™ MAC video laryngoscope with that of the Macintosh laryngoscope in first-year residents rotating at an anaesthesiology department. METHODS: This randomized controlled study enrolled first-year residents who completed a 2-month rotation at an anaesthesiology department. Each rotation group was randomly assigned to the Macintosh laryngoscope (ML) or McGRATH™ MAC video laryngoscope (MML) group...

Introduction: Hospitalizations during the coronavirus 2019 (COVID-19) pandemic peaked in New York in March-April 2020. In the months following, emergency department (ED) volumes declined. Our objective in this study was to examine the effect of this decline on the procedural experience of emergency medicine (EM) residents compared to the pre-pandemic period. Methods: We conducted this multicenter, retrospective cohort study of patients seen and key procedures performed by EM residents at hospitals spanning three Accreditation Committee for Graduate Medical Education-approved EM residencies in New York City and Nassau County, NY...

Airway management is a fundamental component of neonatal critical care and requires a high level of skill. Neonatal endotracheal intubation (ETI), bag-mask ventilation, and supraglottic airway management are complex technical skills to acquire and continually maintain. Simulation training has emerged as a leading educational modality to accelerate the acquisition of airway management skills and train interprofessional teams. However, current simulation-based training does not always replicate neonatal airway management needed for patient care with a high level of fidelity...

Background  Medical simulation allows clinicians to safely practice the procedural skill of endotracheal intubation. Applied force to oropharyngeal structures increases the risk of patient harm, and video laryngoscopy (VL) requires less force to obtain a glottic view. It is unknown how much force is required to obtain a glottic view using commercially available simulation manikins and if variability exists. This study compares laryngoscopy force for a modified Cormack-Lehane (CL) grade I view in both normal and difficult airway scenarios between three commercially available simulation manikins...

In mechanically ventilated severe acute respiratory distress syndrome patients, spontaneous inspiratory effort generates more negative pressure in the dorsal lung than in the ventral lung. The airflow caused by this pressure difference is called pendelluft, which is a possible mechanisms of patient self-inflicted lung injury. This study aimed to use computer simulation to understand how the endotracheal tube and insufficient ventilatory support contribute to pendelluft. We established two models. In the invasive model, an endotracheal tube was connected to the tracheobronchial tree with 34 outlets grouped into six locations: the right and left upper, lower, and middle lobes...

OBJECTIVE: The incidence of skin/tissue damage, such as pressure ulcers, remains high in mechanically ventilated patients in the prone position. According to guidelines, critically ill patients with acute respiratory distress syndrome (ARDS) should be prone for at least 12-16 hours to improve oxygenation and decrease mortality. Therefore, educating clinicians on how to reposition and manage the patient safely in a prone position plays a vital role in preventing adverse events. This project aimed to develop accessible online educational content to assist clinicians in safely executing the prone manoeuvre and minimise skin/tissue damage...

BACKGROUND: During endotracheal intubation, extubation, tracheotomy, and tracheotomy tube replacement, the splashed airway secretions of patients will increase the risk of transmission of SARS-CoV-2 and many other potential viral and bacterial diseases, such as influenza virus, adenovirus, respiratory syncytial virus, rhinovirus, Middle East respiratory coronavirus syndrome (MERS-CoV), Streptococcus pneumoniae, and Mycobacterium tuberculosis. Therefore, it is necessary to establish a barrier between patients and medical workers to reduce the risk of operators' infection with potentially pathogenic microorganisms...

BACKGROUND: Airway management in life-threatening emergencies is essential for children, and endotracheal intubation is the gold standard. It protects against regurgitation and enables mechanical ventilation. New types of airway management equipment are being developed and implemented to meet the needs of medical personnel. RESEARCH DESIGN AND METHODS: This prospective, randomized, cross-over simulation trial evaluated the success of endotracheal intubation in three scenarios: normal airway (scenario-A), tongue edema (scenario-B), and continuous chest compression (scenario-C), using the bébé Vie Scope™ laryngoscope (VieScope) and the Macintosh blade larynoscope (MAC) as a comparative tool performed by nurses with limited tracheal intubation experience...

Robotic sciences have rapidly advanced and revolutionized various aspects of medicine, including the field of airway management. Robotic endotracheal intubation is an innovative method that utilizes robotic systems to aid in the accurate placement of an endotracheal tube within the trachea. This cutting-edge technique shows great promise in improving procedural precision and ensuring patient safety. In this comprehensive overview, we delve into the present status of robotic-assisted endotracheal intubation, examining its advantages, obstacles, and the potential implications it holds for the future...

BACKGROUND: The appropriate management of a "difficult airway" remains a challenge for novices and experienced anaesthetists. With the current available airway technologies, e.g., video laryngoscopy, flexible bronchoscopy (fibreoptic intubation (FOI)) for endotracheal intubation is decreasing, likely diminishing caregiver skills. We investigated whether bronchoscopy simulator training improved FOI skills. METHODS: 72 volunteers, consisting of anaesthetists, anaesthesia residents, and nurses, performed six exercises on a bronchoscopy simulator...