Cumulative Sum learning curves (CUSUM) in basic anaesthesia procedures

Ospina, Óscar David Aguirre; Medina, Ángela María Ríos; Marulanda, Mauricio Calderón; Buitrago, Luz María Gómez

doi:10.1016/j.rcae.2014.04.005

Cited by 15 publications

(12 citation statements)

References 15 publications

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“…Furthermore, the effect of previous ultrasound experience on the learning curve would be speculative with only 8 residents declaring such familiarity. Last, number of residents may be inadequate to generalize the minimum number of attempts for all learners but most CUSUM studies of anesthesia have number of subjects lower than 16 …”

Section: Discussionmentioning

confidence: 99%

“…We calculated and graphed CUSUM curves according to the formulas given in Table in Excel Program (Microsoft Office 2016). Conventionally, α and β values are established as 0.1 and the percentage of unacceptable failure (p1) is usually twice the percentage of acceptable failure (p0) . In this analysis, we set α and β as 0.1, and determined acceptable failure ratio (p0) as 0.2 with unacceptable failure ratio (p1) as 0.4.…”

Section: Methodsmentioning

confidence: 99%

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Learning curve of ultrasound measurement of subglottic diameter for endotracheal tube selection in pediatric patients

Orhan-Sungur

Altun

Seyhan

et al. 2019

Pediatric Anesthesia

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Background: Endotracheal tube size can be predicted according to ultrasound measurement of subglottic airway diameter. The learning curve for this method is not yet established. The aim was to evaluate the learning curve of anesthesiology residents in ultrasound measurement of subglottic airway diameter for prediction of endotracheal tube size using cumulative sum analysis. Methods:Sixteen anesthesiology residents measured transverse subglottic airway diameter in children undergoing general anesthesia with cuffed endotracheal intubation. Each resident performed 30 ultrasound examinations. Primary outcome was the successful prediction of endotracheal tube size according to ultrasound measurement. Cumulative sum analysis was performed with acceptable and unacceptable failure rates set as 20 and 40%, respectively.Results: Ten out of 16 residents (62.5%) were deemed successful as they were able to pass lower decision boundary, whereas six residents' CUSUM scores were between the decisions lines deeming them indeterminate. The overall success rate for determining the correct endotracheal tube size was 77.5%. Median number of attempts to cross lower decision boundary was 29 with minimum of 18 and maximum of 29 attempts among successful residents. Conclusion:Learning curves constructed with cumulative sum analysis in this study showed that only 62.5% of residents were able to correctly predict cuffed endotracheal tube size with 80% success rate. Considerable variability in achieving competency necessitates objective follow-up of individual improvement. K E Y W O R D S endotracheal tube, learning curve, measurement, pediatric airway, ultrasound | 1195 ORHAN-SUNGUR et Al.when compared with magnetic resonance imaging in healthy adults and authors claimed that ultrasound was simple to learn despite operator dependency of the technique. However, this claim is not tested in pediatric patients with novice users. Therefore, in this prospective clinical trial-which is a part of assessment of pediatric airway and lung ultrasound learning-we aimed to evaluate the learning curve of anesthesiology residents in measurement of subglottic airway diameter for prediction of endotracheal tube size by cumulative sum (CUSUM) analysis. Our primary outcome was the successful prediction of endotracheal tube size by measuring transverse diameter of the subglottis. | MATERIAL S AND ME THODSApproval of Clinical Research Ethics Committee (2017/847) and written informed consent from anesthesiology residents and parents were obtained. Sixteen anesthesiology residents were included in the study to evaluate subglottic airway diameter in children aged between 1 and 8 years presented for adenoidectomy, tonsillectomy, or both who received general anesthesia with cuffed endotracheal intubation. Children with known tracheal and laryngeal pathologies, respiratory diseases, and anticipated difficult airway, as well as overweight or underweight children (body mass index above the 85th percentile or less than the 5th percentile, respectively), were excluded. A...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Learning curve of ultrasound measurement of subglottic diameter for endotracheal tube selection in pediatric patients

Orhan-Sungur

Altun

Seyhan

et al. 2019

Pediatric Anesthesia

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“… 110 – 112 It has been estimated that over 50–60 conventional oro-tracheal procedures were necessary for a novice to reach a 90% success rate. 110 , 113 With videolaryngoscopy, this number may drop to less than ten procedures. 112 , 114 Even if the majority of the literature identified steeper learning curves and shorter intubation time with videolaryngoscopy, negative studies exist and this technique still requires appropriate training.…”

Section: Resultsmentioning

confidence: 99%

Anaesthesia in austere environments: literature review and considerations for future space exploration missions

et al. 2018

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Future space exploration missions will take humans far beyond low Earth orbit and require complete crew autonomy. The ability to provide anaesthesia will be important given the expected risk of severe medical events requiring surgery. Knowledge and experience of such procedures during space missions is currently extremely limited. Austere and isolated environments (such as polar bases or submarines) have been used extensively as test beds for spaceflight to probe hazards, train crews, develop clinical protocols and countermeasures for prospective space missions. We have conducted a literature review on anaesthesia in austere environments relevant to distant space missions. In each setting, we assessed how the problems related to the provision of anaesthesia (e.g., medical kit and skills) are dealt with or prepared for. We analysed how these factors could be applied to the unique environment of a space exploration mission. The delivery of anaesthesia will be complicated by many factors including space-induced physiological changes and limitations in skills and equipment. The basic principles of a safe anaesthesia in an austere environment (appropriate training, presence of minimal safety and monitoring equipment, etc.) can be extended to the context of a space exploration mission. Skills redundancy is an important safety factor, and basic competency in anaesthesia should be part of the skillset of several crewmembers. The literature suggests that safe and effective anaesthesia could be achieved by a physician during future space exploration missions. In a life-or-limb situation, non-physicians may be able to conduct anaesthetic procedures, including simplified general anaesthesia.

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“…The cannulation practitioners in our study performed arterial cannulation in at least 40 cases with either method to become familiar with the techniques. The minimum number of cases required was determined by previously reported learning curves and recommendations for ensuring patient safety [19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided dynamic needle tip positioning technique for radial artery cannulation in elderly patients: A prospective randomized controlled study

Kim

Jeong

et al. 2021

PLoS ONE

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Background Radial artery cannulation, which is a useful procedure for anesthetic management, is often challenging in elderly patients. Recently, the dynamic needle tip positioning (DNTP) technique was introduced to facilitate ultrasound-guided vascular catheterization. Therefore, we performed this prospective, parallel group, randomized, controlled trial to compare the ultrasound-guided DNTP technique with the palpation method in elderly patients. Methods For this study, 256 patients aged 65 years or older were randomly allocated to the ultrasound-guided DNTP technique group (DNTP group) or the palpation method group (palpation group). The primary outcome was first-attempt success rate. The secondary outcomes were overall success rate, numbers of attempts and redirections, cannulation time, and incidence of complications. Results The first-attempt success rate (85.9% vs. 72.3%; relative risk [RR], 1.47; 95% CI 1.25–1.72; P<0.001) and the overall success rate (99.2% vs. 93.0%; RR, 1.07; 95% CI 1.02–1.12; P = 0.01) were significantly higher in the DNTP group compared to the palpation group. The numbers of attempts [1 (1,1) vs. 1 (1,3), P<0.001] and redirections [0 (0,1) vs. 2 (0,4), P<0.001] were significantly lower in the DNTP group. The cannulation time for successful attempts was 42 (32,55) seconds in the DNTP group and 53 (36,78) seconds in the palpation group (P<0.001). The incidence of hematoma was significantly lower in the DNTP group (7% vs. 24.2%; RR, 0.29; 95% CI, 0.14–0.59; P<0.001). Conclusions Ultrasound-guided radial artery cannulation with the DNTP technique improved the efficiency of radial artery cannulation in elderly patients by increasing the success rate while minimizing complications.

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Cumulative Sum learning curves (CUSUM) in basic anaesthesia procedures

Cited by 15 publications

References 15 publications

Learning curve of ultrasound measurement of subglottic diameter for endotracheal tube selection in pediatric patients

Learning curve of ultrasound measurement of subglottic diameter for endotracheal tube selection in pediatric patients

Anaesthesia in austere environments: literature review and considerations for future space exploration missions

Ultrasound-guided dynamic needle tip positioning technique for radial artery cannulation in elderly patients: A prospective randomized controlled study

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