Use of Biomechanical Motion Analysis to Evaluate Endotracheal Intubation Skill in a Simulated Clinical Setting

Title from PDF of title page, viewed on August 25, 2015Thesis advisor: Gregory W. KingVitaIncludes bibliographic references (pages 102-107)Thesis (M.S.)--School of Computing and Engineering. University of Missouri--Kansas City, 2015This study evaluated, using motion capture technology, the performance characteristics of novice and experienced medical personnel performing endotracheal intubation in a simulated clinical setting. Few objective measures exist that quantify the differences in intubation techniques between providers of various skill levels. These measures are inadequate for providing useful feedback towards training or performance-based research. Motion analysis may be a potential solution for the quantitative evaluation of endotracheal intubation among healthcare professionals of different skill levels. This study hypothesized that experienced personnel would exhibit movement patterns associated with higher performance and efficiency when compared to novice personnel. Twelve subjects were recruited for this study, among whom eight were novice participants and four were expert participants, based on the number of times they had performed endotracheal intubation. Each subject donned a full body 41 marker motion capture suit and performed simulated endotracheal intubation on an Airway mannequin using a Macintosh blade-fitted laryngoscope. Intubation success was defined by visible lung inflation of the mannequin. The obtained motion capture data was used to calculate path length, average path speed and use time of the laryngoscope, as well as the overall intubation time. Angular ranges of motion were calculated for the left wrist, elbow, the neck, and both knees of study subjects. Experts, when compared to novices, intubate faster and with lower overall movement (path length). One way ANOVA and two sample t-tests were conducted on all outcome variables, wherein significant p-values were obtained from the wrist abduction/adduction (p = 0.009) and elbow abduction/adduction (p=0.002) ranges of motion among novices and experts, indicating significant difference. Combined with a lower completion time and the lower overall laryngoscope movement, the lower range of motion for the wrist and the elbow in experts may indicate that experts are implementing finer, more economic maneuvers in order to achieve successful intubation. These results supports the study hypothesis that experienced personnel, compared to novice, will exhibit measurable movement patterns associated with higher performance and efficiency.Introduction -- Background -- Study -- Conclusion -- Appendix A. Equipment photographs, layout schematics, study illustrations -- Appendix B. Tables -- Appendix C. MATLAB Code -- Appendix D. Study forms and document

Year in review in Intensive Care Medicine, 2008: II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation

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Reporting and improving quality of cardiopulmonary resuscitation (CPR) during out of hospital cardiac arrest.

Cand.med Jo Kramer-Johansen (f.1969) has studied how quality of CPR can be measured and modified by automated feedback during out of hospital cardiac arrest. The results from 284 episodes of cardiac arrest treated in the ambulance services of Akershus, London, and Stockholm show variable and poor quality of CPR characterized by too shallow chest compressions and too many and too long pauses. In the thesis he discusses and recommends standards for measuring and reporting CPR quality for the purposes of avoiding confounded clinical trials and for quality assurance and improvement in all professional services. The Norwegian Air Ambulance Foundation supported this work with a full time scholarship. Supervisors have been Professor Petter Andreas Steen and Lars Wik (NAKOS)

Pulmonary Gas Transport and Drug Delivery in a Patient Specific Lung Model During Invasive High Frequency Oscillatory Ventilation

The objective of this dissertation research was to investigate gas transport, mixing and aerosol-drug delivery during high frequency oscillatory ventilation (HFOV) for various ventilator specific conditions that are vital to critical care clinicians. A large eddy simulation based computational fluid dynamics approach was used in a patient specific human lung model to analyze the effect of invasive HFOV on patient management. Different HFOV waveform shapes and frequencies was investigated and the square waveform was found to be most efficient for gas mixing; resulting in the least wall shear stress on the lung epithelium layer thereby reducing the risk of barotrauma to both airways and the alveoli for patients undergoing therapy. Traditional (outlet) boundary conditions based on mass fraction or outlet pressures were found to be inadequate in describing the complex flow physics that occurs during HFOV. Physiological boundary conditions that used the time-dependent pressure coupled with the airways resistance and compliance (R&C) were derived and used for the first time to investigate the lung lobar ventilation and gas exchange for accurate HFOV modeling. A Lagrangian approach was then used to model gas-solid two-phase flow that allowed investigation of the potential of aerosol-drug delivery under HFOV treatment. We report, for the first time, computational fluid dynamics studies to investigate the possibilities of aerosol drug delivery under HFOV. Understanding the role of different carrier gases on the gas exchange and particle deposition, which may allow for optimum drug delivery and ventilation strategy during HFOV. Increasing the operating frequency resulted in a significant change in the global and local deposition indicating strong dependency on the frequency, which could be beneficial for the targeted drug delivery. The global deposition as a fraction of the total injected particles at the endotracheal tube inlet was equivalent to the cases of normal breathing and conventional mechanical ventilation signifying a potential for efficient drug delivery during HFOV. In addition, HFOV had a unique characterization of the local particle deposition due to the rapid ventilation process and a strong influence of the endotracheal tube jet. Very often during ventilation therapy, a clinician uses a cocktail of various gases to enhance targeted therapy. To quantify this process for a futuristic HFOV based patient management, we undertook detailed studies to understand the role of carrier gas properties in gas exchange and particle transport during HFOV. A substantial amplification of the pendelluft flow was achieved by utilizing a low-density carrier gas instead of air, which resulted in gas exchange improvement. Reducing the carrier gas density was found to significantly alter the aerosol-drug delivery under HFOV management. As the density decreased, the deposition fraction in the upper tracheobronchial tree decreased, indicating enhancement of the lung periphery delivery. Furthermore, the filtered aerosol-drug in the ventilator circuit could be significantly reduced by using Heliox, and further reduction could be achieved by reducing the operating frequency. In general, high-frequency oscillatory ventilation therapy could be improved under Heliox with greater content of Helium, thereby reducing the lung hyperinflation risk

The development of evidence-based guidelines to inform the extrication of casualties trapped in motor vehicles following a collision

Background Motor vehicle collisions (MVCs) are a common cause of injury and death throughout the world. Following an MVC some patients will remain in their vehicles due to injury, the potential for injury or physical obstruction. Extrication is the process of removing injured or potentially injured patients from vehicles following a motor-vehicle collision. Current extrication practices are based on the principles of 'movement minimisation' with the purpose of minimising the incidence of avoidable secondary spinal injury. Movement minimisation adds time to the process of extrication and may result in an excess morbidity and mortality for patients with time dependent injuries. The current extrication approach has evolved without the application of evidence-based medicine (EBM) principles. The principles of EBM; consideration of the relevant scientific evidence, patient values and preferences and expert clinical judgement are used as a framework for this thesis. Aims and Objectives To develop evidence-based guidance for the extrication of patients trapped in motor vehicles by applying EBM principles to this area of practice. This will be achieved through: - Describing the injury patterns, morbidity and mortality of patients involved in MVCs (trapped and not trapped). - To analyse the movement associated with and the time taken to deliver across a variety of extrication methods. - Determining the perceptions of patients who have undergone vehicle extrication and describe their experiences of extrication. - Developing consensus-based guidelines for extrication

Fusion, 2022

https://hsrc.himmelfarb.gwu.edu/smhs_fusion/1014/thumbnail.jp

Management of adult benign laryngotracheal stenosis

Upper airway stenosis has a significant impact on the quality of life and sometimes on life itself. The incidence of this condition is likely to be increasing as survival rates following periods of ventilation on Intensive Care Units (ICUs) improve (1, 2). Paediatric laryngotracheal stenosis is a well researched discipline and treatment includes airway augmentation with rib grafts and tracheal or cricotracheal resection with end-to-end anastomosis. At the start of my research, in 2005, adult laryngotracheal stenosis was poorly researched and the treatment options were tracheostomy, tracheal resection or cricotracheal resection, each with associated morbidity and mortality. This thesis investigates the aetiology, incidence, screening and alternative treatment options, which include endoscopic techniques, for the management of acquired adult benign laryngotracheal stenosis. The commonest causes for this condition are ventilation on intensive care units and inflammatory disorders such as Wegener's granulomatosis, idiopathic subglottic stenosis and sarcoidosis. In January 2004 a prospective database was set up in the busiest airway reconstruction unit in the United Kingdom. Data was collected on all new adult patients with upper airways stenosis. At the completion of this research in January 2010, 400 patients had been entered on this database. Due to the rarity of this condition, it was not possible to design randomised trials to compare different treatment options. This thesis is an integrated series of prospective cohort studies, with the aim of developing a greater understanding of adult airway stenosis, with a particular emphasis on minimally invasive endoscopic techniques. This research has shown that 72% of patients with post-intubation airway stenosis can be treated with these minimally invasive endoscopic techniques. Effective new treatments have been devised for the management of inflammatory stenoses when the results of previous treatments had not been effective. New tools for assessing the airway and outcome measures have also been proposed

Towards respiratory muscle-protective mechanical ventilation in the critically ill: technology to monitor and assist physiology

Inadequate delivery of ventilatory assist and unphysiological respiratory drive may severely worsen respiratory muscle function in mechanically ventilated critically ill patients. Diaphragm weakness in these patients is exceedingly common (>60% of patients) and associated with poor clinical outcomes, including difficult ventilator liberation, increased risks of intensive care unit (ICU) and hospital readmission, and mortality. The underlying mechanisms of diaphragm dysfunction were extensively discussed in this thesis. Pathways primarily include the development of diaphragm disuse atrophy due to muscle inactivity or low respiratory drive (strong clinical evidence), and diaphragm injury as a result of excessive breathing effort due to insufficient ventilator assist or excessive respiratory drive (moderate evidence, mostly from experimental work). Excessive breathing effort may also worsen lung injury through pathways that include high lung stress and strain, pendelluft, increased lung perfusion, and patient-ventilator dyssynchrony. Relatively little attention has been paid to the effects of critical illness and mechanical ventilation on the expiratory muscles; however, dysfunction of these muscles has been linked to inadequate central airway clearance and extubation failure. The motivation for performing the work presented in this thesis was the hypothesis that maintaining physiological levels of respiratory muscle activity under mechanical ventilation could prevent or attenuate the development respiratory muscle weakness, and hence, improve patient outcomes. This strategy, integrated with lung-protective ventilation, was recently proposed by international experts from different professional societies (this thesis), and is referred to as a combined lung and diaphragm-protective ventilation approach. Today, an important barrier for implementing and evaluating such an approach is the lack of feasible, reliable and well-understood modalities to assess breathing effort at the bedside, as well as strategies for assisting and restoring respiratory muscle function during mechanical ventilation. Furthermore, monitoring breathing effort is crucial to identify potential relationships between patient management and detrimental respiratory (muscle) function that can be targeted to improve clinical outcomes. In this thesis we identified and improved monitoring modalities for the diaphragm (Part I), we investigated the impact of mechanical ventilation on the respiratory pump, especially the diaphragm (Part II), and we evaluated a novel strategy for maintaining expiratory muscle activity under mechanical ventilation (Part III)

Proceedings - Wright State University Boonshoft School of Medicine Eighth Annual Medical Student Research Symposium: Celebrating Medical Student Scholarship

The student abstract booklet is a compilation of abstracts from students\u27 oral and poster presentations at Wright State University\u27s Eighth Annual Boonshoft School of Medicine Medical Student Research Symposium held on April 13, 2016.https://corescholar.libraries.wright.edu/ra_symp/1007/thumbnail.jp