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. 2021 Oct 6;7(4):e29899.
doi: 10.2196/29899.

Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial

Regina L Toto  1 , Ethan S Vorel  1 , Khoon-Yen E Tay  1 , Grace L Good  1 , Jesse M Berdinka  2 , Adam Peled  2 , Marion Leary  3 , Todd P Chang  4 , Anna K Weiss  1 , Frances B Balamuth  1
Affiliations

Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial

Regina L Toto et al. JMIR Med Educ. .

Abstract

Background: Septic shock is a low-frequency but high-stakes condition in children requiring prompt resuscitation, which makes it an important target for simulation-based education.

Objective: In this study, we aimed to design and implement an augmented reality app (PediSepsisAR) for septic shock simulation, test the feasibility of measuring the timing and volume of fluid administration during septic shock simulation with and without PediSepsisAR, and describe PediSepsisAR as an educational tool. We hypothesized that we could feasibly measure our desired data during the simulation in 90% of the participants in each group. With regard to using PediSepsisAR as an educational tool, we hypothesized that the PediSepsisAR group would report that it enhanced their awareness of simulated patient blood flow and would more rapidly verbalize recognition of abnormal patient status and desired management steps.

Methods: We performed a randomized controlled feasibility trial with a convenience sample of pediatric care providers at a large tertiary care pediatric center. Participants completed a prestudy questionnaire and were randomized to either the PediSepsisAR or control (traditional simulation) arms. We measured the participants' time to administer 20, 40, and 60 cc/kg of intravenous fluids during a septic shock simulation using each modality. In addition, facilitators timed how long participants took to verbalize they had recognized tachycardia, hypotension, or septic shock and desired to initiate the sepsis pathway and administer antibiotics. Participants in the PediSepsisAR arm completed a poststudy questionnaire. We analyzed data using descriptive statistics and a Wilcoxon rank-sum test to compare the median time with event variables between groups.

Results: We enrolled 50 participants (n=25 in each arm). The timing and volume of fluid administration were captured in all the participants in each group. There was no statistically significant difference regarding time to administration of intravenous fluids between the two groups. Similarly, there was no statistically significant difference between the groups regarding time to verbalized recognition of patient status or desired management steps. Most participants in the PediSepsisAR group reported that PediSepsisAR enhanced their awareness of the patient's perfusion.

Conclusions: We developed an augmented reality app for use in pediatric septic shock simulations and demonstrated the feasibility of measuring the volume and timing of fluid administration during simulation using this modality. In addition, our findings suggest that PediSepsisAR may enhance participants' awareness of abnormal perfusion.

Keywords: application; augmented reality; children; fluid administration; pediatrics; septic shock; simulation; simulation-based education.

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Conflict of interest statement

Conflicts of Interest: BrickSimple, LLC, which employs JMB and AP, received compensation from the project funding described above for creating the augmented reality app described in this manuscript. ML has licensed intellectual property for virtual reality cardiopulmonary resuscitation applications. TPC has grant funding for research and development from Oculus/Facebook and is a medical advisor to A.i.Solv/i3 Simulations, which is not affiliated with this product or company in this manuscript.

Figures

Figure 1
Figure 1
PediSepsisAR overlaid on the simulation mannequin, as visualized through the HoloLens.
Figure 2
Figure 2
The sequence of communication between the potentiometer and HoloLens. Note that the potentiometer is embedded within the syringe displayed at the left. TCP: transmission control protocol.
Figure 3
Figure 3
Push-pull technique for fluid administration. Fluid is manually pulled from the bag reservoir and then pushed into the patient.
See this image and copyright information in PMC

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