Infant bronchial tree simulator: Success of a built-from-scratch model for single lung isolation

• Published in: Surgery 2024-12, Vol.176 (6), p.1683-1687
• Main Authors: Patel, Raj K., Gupta, Ruchika, Reinhart, Elizabeth S., Putnam, Elizabeth, Weadock, Willam, Rooney, Deborah M.
• Format: Article
• Language: English
• Subjects: Bronchi - diagnostic imaging; Bronchoscopy - education; Bronchoscopy - methods; Clinical Competence; Humans; Infant; Intubation, Intratracheal - methods; Models, Anatomic; One-Lung Ventilation - methods; Simulation Training - methods; Tomography, X-Ray Computed
• ISSN: 0039-6060; 1532-7361; 1532-7361
• DOI: 10.1016/j.surg.2024.08.011

One-lung ventilation in infants is a high-risk procedure. Complications include endotracheal tube occlusion, with grave consequences. Although there are commercially available bronchoscopy simulators, there are no realistic models of infant patients. This limits access to training opportunities that would ensure safe and efficient lung isolation. To bridge this gap, we developesd a realistic infant bronchial tree model for single lung intubation and evaluated preliminary validity evidence of its features and clinicians’ ability to perform critical skills associated with pediatric one-lung ventilation. Using computed tomography imaging, a stereolithography file of an infant airway was generated to 3D print a model. This model was inserted into a commercially available airway trainer to allow lung isolation using standard bronchoscopy techniques. Ten experienced pediatric anesthesiologists independently evaluated the simulator’s physical attributes, realism, value, and relevance using a 29-item paper survey and rated using 4-point rating scales (4 = highest). Participants’ ability to complete 5 critical tasks was self-reported using 5-point rating scales (5 = too easy). Item and domain mean ratings were calculated, and comments reviewed. Overall, reviews were positive, with mean scores indicating adequate realism and high value. Specific challenges were associated with right mainstem bronchus and upper lobe takeoff. Performance scores indicated that most tasks were “somewhat easy to perform,” suggesting that the model’s anatomy did not hinder physicians’ ability to perform one-lung ventilation. Preliminary findings indicate that the novel simulator holds promise for training in lung isolation techniques after refinement. Future research will target refinement, expanding evaluation, and developing a comprehensive curriculum and competency assessment program.