Tracheal intubation in patients with Pierre Robin sequence: development, application, and clinical value based on a 3-dimensional printed simulator

Background: The main clinical manifestations of patients with Pierre Robin sequence (PRS) include micrognathia, the glossoptosis and dyspnoea. The difficulty of tracheal intubation (TI) in such patients is increased.Objective: The purpose of the study was to evaluate the reliability and efficacy of the PRS simulator.Methods: A PRS simulator was developed by using 3-dimensional (3D) printing technology under computer-aided design. A total of 12 anaesthesiologists each trained 5 times for TI on the PRS Training Simulator-1 and recorded the simulation time. After the training, they were randomly divided into three groups with a total of 12 nontrained anaesthesiologists, and the simulation was completed on PRS Simulator-2, 3 and 4. The simulation time was recorded, and the performance was evaluated by three chief anaesthesiologists. Then, all 24 anaesthesiologists completed the questionnaire.Results: A PRS simulator developed by 3D printing was used to simulate the important aspects of TI. The average number of years worked was 6.3 ± 3.1 years, and 66.7% were female. The time for the 12 anaesthesiologists to complete the training gradually decreased (p < 0.01). Compared with the trained anaesthesiologists, the simulation time of TI in the nontrained anaesthesiologists was much longer (all p < 0.01). In addition, the simulation performance of the trained anaesthesiologists was relatively better (all p < 0.01).Conclusion: The reliability and efficacy of the PRS simulator is herein preliminarily validated, and it has potential to become a teaching and training tool for anaesthesiologists

Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China:lessons learnt and international expert recommendations

Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (Sao2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (Sao2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients

The Development and Application of Regional Education Informatization in China

Education informatization has become a significant symbol of educational modernization. Over the past 20 years, China has made remarkable achievements in the development of information technology infrastructure, resources, and personnel training. Despite the initial success on the education informatization management, China is still facing many challenges in primary and secondary schools’ education informatization: ineffective digital educational resource sharing mechanism (lack of public information technology service platform), insufficient quality education resources (i.e., campus network infrastructure and teachers’ information technology capabilities), poorly integrated education informationalized system management (i.e., slow deployment and limited functionality), insufficient information capabilities training for the teacher, imbalanced development in regional education informatization (i.e., funding shortage in rural areas), and lack of sustainable development policies. Thus, how to resolve these challenges and to prepare primary and secondary schools for the 21st century classroom has become an urgent issue in reaching China’s ambitious goal of 100% network connection. By examining the current status of education informationalized development in three different economic areas in China, this chapter collects, complies, compares, and evaluates the application and development of regional education informatization including information technology hardware, informational network, information capabilities, and education informatization development funds in primary and secondary schools. Recommendations are made to improve the process of education informatization development and application; to reduce the regional gaps in education informatization; to accelerate the development of network resources, network infrastructure, and informationalized platform; to improve information technology capability training; and to establish better policies for sustainable development of education informatization in China. </jats:p