Design and Evaluation of a Low-Cost Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Simulator

Abstract

Introduction: Bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT) is an invasive procedure regularly performed in the intensive care unit. Risk of serious complications have been estimated in up to 5%, focused during the learning phase. We have not found any published formal training protocols, and commercial simulators are costly and not widely available in some countries. The objective of this study was to present the design and simulator performance of a low-cost BG-PDT simulator.

Methods: A simulator was designed with materials available in a hardware store, synthetic skin pads, ex vivo bovine tracheas, and a pipe inspection camera. The simulator was tested in 8 experts and 9 novices. Sessions were video recorded, and participants were equipped with the Imperial College Surgical Device, a hand motion-tracking device. Performance was evaluated with a multimodal approach, including first attempt success rate, global success rate, total procedural time, Imperial College Surgical Device-derived proficiency parameters, and global rating scale applied blindly by 2 expert observers. A satisfaction survey was applied after the procedure.

Results: A simulator was successfully constructed, allowing multiple iterations per assembly, with a fixed cost of US $30 and $4 per use. Experts had greater global and first attempt success rate, performed the procedure faster, and with greater proficiency. It presented high user satisfaction and fidelity.

Conclusions: A low-cost BG-PDT simulator was successfully constructed, with the ability to discriminate between experts and novices, and with high fidelity. Considering its ease of construction and cost, it can be replicated in almost any intensive care unit.

FIGURE 1

Step-by-step construction of the simulator. A, PVC tube attached to cutting board. B, Bovine trachea fastened to cutting board with zip ties. C, PVC tube with 8 × 8-cm window. D, Synthetic skin pad fixed to screws. E, USB pipe inspection camera used as bronchoscopy.

FIGURE 2

Bronchoscopy-guided PDT performance in the simulator and ICSAD installation. A, ICSAD sensors (installed in the dorsum of the operator's hand) and field generator. B, Tracheal palpation and puncture. C, Guidewire insertion. D, Progressive dilatation. E, Cannulation.