The Construction Of Learning Curves For Endotracheal Intubation By Seeing Optical Stylet

[PURPOSE]The aim of this study is to find out how easy it is to leam to use Shikani Optical Stylet(S.O.S) for endotracheal intubation by the way of constructing learning curves,so as to provide some clinical foundation.[METHODS]From March 2007 to March 2008,9 post-graduate-l-year residents at Zhongshan Hostpital of Fudan University completed a 6-month anesthesia rotation.Each resident received the same training on the first day of the rotation.Thus, this study makes the assumption that all participating interns start with the same baseline intubation experience.All residents underwent a didactic instruction on intubation of S.O.S.by an experienced professor before the initiation of their measured experience.To standardize the patient population,eligibility criteria of patients were those aged 18 to 80 years old and ASA classâ… orâ…¡,undergoing elective surgery under general anesthesia.For the intubation task,target success rate was set at 98%.This success rate was determined via consensus of the anesthesia department of Zhongshan Hospital.Record the time of intubation,whether the attempt is successful or not,some important circulation indexes before and after the intubation(HR, Bp,SpO₂).The CUSUM equation is defined asσ=Xi—Xo,whereσis the cumulative sum.As a premise,every procedure has an inherent failure rate.The target success rate for intubation was set at 98%by our hospital.Thus,the inherent failure rate was defined at 2%or 0.02.The score,after each attempt,was sequentially added to the cumulative score and plotted a graph.Graphs were then analyzed on the basis of their slope.The portion of the curve where the maximal change in slope begins to decrease signifies the end of the initial learning process(ie,"getting off the learning curve").[RESULTS]Figure 5-13 demonstrate individual intern successes plotted versus attempts.Thus,a CUSUM analysis is done for each resident.When this data are summated(ie,all first attempts are summed and then added to all second attempts, and subsequent attempts),Table 11 is formed.This table demonstrates the cumulative summation data for all residents at each of the intubation skill.The cumulative summated data are demonstrated in figs.14.This curve represents the success of the total group.Thus,the point at which the change of slope decreases indicates the number of procedures necessary for the average first-year residents to get off of the learning curve.This point was estimated at 7 attempts.[CONCLUSIONS]Cumulative summation for all residents plotted against the number of attempts at endotracheal intubation.The point at which the average intern comes off of he learning curve is approximately 7.It is a favorable and useful skill,what's more,it can be learned very quickly.So it is highly recommended in the clinical work.