{"title":"评估气管插管工效学:从业人员经验和喉镜类型","authors":"Soichiro Inoue, Kosuke Hamabe, Hirokiyo Nomura","doi":"10.1111/anae.16482","DOIUrl":null,"url":null,"abstract":"<p>We read with interest the study by Ding et al. [<span>1</span>]. The application of augmented reality technology to medical procedures is a promising advancement, and we concur with the authors' perspective on its potential to reduce occupational health risks in medical professions, while also enhancing procedural safety and accuracy. We have a concern about the study's data on Macintosh and videolaryngoscopes. It is unclear if the results are generalisable without accounting for the practitioners' proficiency levels.</p>\n<p>We conducted a series of studies investigating the postural changes and gaze distribution during tracheal intubation in a simulation setting using motion capture and eye-tracking, focusing on comparisons between novice and experienced practitioners [<span>2, 3</span>]. The vertical head movement during tracheal intubation using the Macintosh laryngoscope differed significantly between novices and experts. Novices exhibited downward movement of 23.5 cm from mouth opening to tracheal tube insertion, whereas the experts showed downward movement of only 3.5 cm [<span>2</span>]. Furthermore, when using the McGrath® videolaryngoscope (Medtronic, Watford, UK), the novices exhibited a downward movement of the head of 10.7 cm, whereas the experts hardly lowered their heads [<span>3</span>].</p>\n<p>Our findings are consistent with those of Ding et al. [<span>1</span>] regarding how the degree of forward flexion varies with the type of laryngoscope used. However, our study further shows that posture during tracheal intubation differs markedly between novices and experts. Specifically, novices exhibit a greater forward flexion, whereas experts maintain a relatively straight posture with minimal head displacement, although the precise angle of upper body flexion was not quantified in our study. Similar findings have been reported in studies using different evaluation methods in simulation settings. Grundgeiger et al. found that novices exhibited significantly more flexion of the trunk and neck compared with experts [<span>4</span>]. Although Ding et al. cited this, they did not mention the differences between novices and experts. In addition, Matthews et al. measured the distance from the patient's nose to the manikin's chin and reported that it was significantly shorter in the novice than the expert group, indicating that novices tended to crouch, while experts maintained a more upright posture during tracheal intubation [<span>5</span>].</p>\n<p>In conclusion, it may not be accurate to claim that all users adopt a forward-leaning posture when using the Macintosh or videolaryngoscope. The failure to account for operator experience may influence the conclusion of such studies significantly, as the degree of forward flexion during tracheal intubation can vary considerably between novices and experts. This possibility of misinterpretation could limit the applicability of augmented reality technology and overestimate its benefit for experienced practitioners. We are also interested in understanding whether there are differences in posture between novices and experts when using this technology for tracheal intubation. A comprehensive understanding of these distinctions is crucial for the effective optimisation of augmented reality technology in clinical practice.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"34 1","pages":""},"PeriodicalIF":7.5000,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluating tracheal intubation ergonomics: practitioner experience and laryngoscope type\",\"authors\":\"Soichiro Inoue, Kosuke Hamabe, Hirokiyo Nomura\",\"doi\":\"10.1111/anae.16482\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>We read with interest the study by Ding et al. [<span>1</span>]. The application of augmented reality technology to medical procedures is a promising advancement, and we concur with the authors' perspective on its potential to reduce occupational health risks in medical professions, while also enhancing procedural safety and accuracy. We have a concern about the study's data on Macintosh and videolaryngoscopes. It is unclear if the results are generalisable without accounting for the practitioners' proficiency levels.</p>\\n<p>We conducted a series of studies investigating the postural changes and gaze distribution during tracheal intubation in a simulation setting using motion capture and eye-tracking, focusing on comparisons between novice and experienced practitioners [<span>2, 3</span>]. The vertical head movement during tracheal intubation using the Macintosh laryngoscope differed significantly between novices and experts. Novices exhibited downward movement of 23.5 cm from mouth opening to tracheal tube insertion, whereas the experts showed downward movement of only 3.5 cm [<span>2</span>]. Furthermore, when using the McGrath® videolaryngoscope (Medtronic, Watford, UK), the novices exhibited a downward movement of the head of 10.7 cm, whereas the experts hardly lowered their heads [<span>3</span>].</p>\\n<p>Our findings are consistent with those of Ding et al. [<span>1</span>] regarding how the degree of forward flexion varies with the type of laryngoscope used. However, our study further shows that posture during tracheal intubation differs markedly between novices and experts. Specifically, novices exhibit a greater forward flexion, whereas experts maintain a relatively straight posture with minimal head displacement, although the precise angle of upper body flexion was not quantified in our study. Similar findings have been reported in studies using different evaluation methods in simulation settings. Grundgeiger et al. found that novices exhibited significantly more flexion of the trunk and neck compared with experts [<span>4</span>]. Although Ding et al. cited this, they did not mention the differences between novices and experts. In addition, Matthews et al. measured the distance from the patient's nose to the manikin's chin and reported that it was significantly shorter in the novice than the expert group, indicating that novices tended to crouch, while experts maintained a more upright posture during tracheal intubation [<span>5</span>].</p>\\n<p>In conclusion, it may not be accurate to claim that all users adopt a forward-leaning posture when using the Macintosh or videolaryngoscope. The failure to account for operator experience may influence the conclusion of such studies significantly, as the degree of forward flexion during tracheal intubation can vary considerably between novices and experts. This possibility of misinterpretation could limit the applicability of augmented reality technology and overestimate its benefit for experienced practitioners. We are also interested in understanding whether there are differences in posture between novices and experts when using this technology for tracheal intubation. A comprehensive understanding of these distinctions is crucial for the effective optimisation of augmented reality technology in clinical practice.</p>\",\"PeriodicalId\":7742,\"journal\":{\"name\":\"Anaesthesia\",\"volume\":\"34 1\",\"pages\":\"\"},\"PeriodicalIF\":7.5000,\"publicationDate\":\"2024-11-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Anaesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/anae.16482\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anaesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/anae.16482","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Evaluating tracheal intubation ergonomics: practitioner experience and laryngoscope type
We read with interest the study by Ding et al. [1]. The application of augmented reality technology to medical procedures is a promising advancement, and we concur with the authors' perspective on its potential to reduce occupational health risks in medical professions, while also enhancing procedural safety and accuracy. We have a concern about the study's data on Macintosh and videolaryngoscopes. It is unclear if the results are generalisable without accounting for the practitioners' proficiency levels.
We conducted a series of studies investigating the postural changes and gaze distribution during tracheal intubation in a simulation setting using motion capture and eye-tracking, focusing on comparisons between novice and experienced practitioners [2, 3]. The vertical head movement during tracheal intubation using the Macintosh laryngoscope differed significantly between novices and experts. Novices exhibited downward movement of 23.5 cm from mouth opening to tracheal tube insertion, whereas the experts showed downward movement of only 3.5 cm [2]. Furthermore, when using the McGrath® videolaryngoscope (Medtronic, Watford, UK), the novices exhibited a downward movement of the head of 10.7 cm, whereas the experts hardly lowered their heads [3].
Our findings are consistent with those of Ding et al. [1] regarding how the degree of forward flexion varies with the type of laryngoscope used. However, our study further shows that posture during tracheal intubation differs markedly between novices and experts. Specifically, novices exhibit a greater forward flexion, whereas experts maintain a relatively straight posture with minimal head displacement, although the precise angle of upper body flexion was not quantified in our study. Similar findings have been reported in studies using different evaluation methods in simulation settings. Grundgeiger et al. found that novices exhibited significantly more flexion of the trunk and neck compared with experts [4]. Although Ding et al. cited this, they did not mention the differences between novices and experts. In addition, Matthews et al. measured the distance from the patient's nose to the manikin's chin and reported that it was significantly shorter in the novice than the expert group, indicating that novices tended to crouch, while experts maintained a more upright posture during tracheal intubation [5].
In conclusion, it may not be accurate to claim that all users adopt a forward-leaning posture when using the Macintosh or videolaryngoscope. The failure to account for operator experience may influence the conclusion of such studies significantly, as the degree of forward flexion during tracheal intubation can vary considerably between novices and experts. This possibility of misinterpretation could limit the applicability of augmented reality technology and overestimate its benefit for experienced practitioners. We are also interested in understanding whether there are differences in posture between novices and experts when using this technology for tracheal intubation. A comprehensive understanding of these distinctions is crucial for the effective optimisation of augmented reality technology in clinical practice.
期刊介绍:
The official journal of the Association of Anaesthetists is Anaesthesia. It is a comprehensive international publication that covers a wide range of topics. The journal focuses on general and regional anaesthesia, as well as intensive care and pain therapy. It includes original articles that have undergone peer review, covering all aspects of these fields, including research on equipment.