评估气管插管工效学:从业人员经验和喉镜类型

IF 7.5 1区 医学 Q1 ANESTHESIOLOGY Anaesthesia Pub Date : 2024-11-21 DOI:10.1111/anae.16482
Soichiro Inoue, Kosuke Hamabe, Hirokiyo Nomura
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引用次数: 0

摘要

我们饶有兴趣地阅读了 Ding 等人的研究报告[1]。将增强现实技术应用于医疗程序是一项大有可为的进步,我们赞同作者的观点,认为它有可能降低医疗行业的职业健康风险,同时还能提高程序的安全性和准确性。我们对研究中有关苹果电脑和视频喉镜的数据表示担忧。我们进行了一系列研究,利用动作捕捉和眼动追踪技术在模拟环境中调查气管插管过程中的姿势变化和目光分布,重点是新手和经验丰富的从业人员之间的比较[2, 3]。在使用 Macintosh 喉镜进行气管插管时,新手和专家的头部垂直运动存在显著差异。从张口到插入气管导管,新手的头部向下移动了 23.5 厘米,而专家的头部向下移动仅为 3.5 厘米[2]。此外,在使用 McGrath® 视频喉镜(美敦力,英国沃特福德)时,新手的头部向下移动了 10.7 厘米,而专家几乎没有低头[3]。然而,我们的研究进一步表明,气管插管时的姿势在新手和专家之间存在明显差异。具体来说,新手表现出更大的前屈,而专家则保持相对平直的姿势,头部移位最小,尽管我们的研究没有量化上半身前屈的精确角度。在模拟环境中使用不同评估方法的研究也有类似发现。Grundgeiger 等人发现,与专家相比,新手表现出的躯干和颈部弯曲明显更多[4]。Ding 等人虽然引用了这一结果,但并未提及新手与专家之间的差异。此外,Matthews 等人测量了从患者鼻子到人体模型下巴的距离,结果发现新手组的距离明显短于专家组,这表明在气管插管过程中,新手倾向于蹲下,而专家则保持更直立的姿势[5]。没有考虑操作者的经验可能会严重影响此类研究的结论,因为新手和专家在气管插管时的前倾程度可能会有很大不同。这种误解的可能性可能会限制增强现实技术的适用性,并高估其对经验丰富的从业人员的益处。我们还有兴趣了解新手和专家在使用该技术进行气管插管时的姿势是否存在差异。全面了解这些差异对于在临床实践中有效优化增强现实技术至关重要。
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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.

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来源期刊
Anaesthesia
Anaesthesia 医学-麻醉学
CiteScore
21.20
自引率
9.30%
发文量
300
审稿时长
6 months
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.
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