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Anesthesiology. 2010 Jun;112(6):1525-31. doi: 10.1097/ALN.0b013e3181d96779.

Learning curves for bag-and-mask ventilation and orotracheal intubation: an application of the cumulative sum method.

Author information

1
Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.

Abstract

BACKGROUND:

In this study, the authors determined the success and failure rates for interns learning bag-and-mask ventilation and orotracheal intubation. Their goal was to determine the amount of experience needed to perform these procedures correctly.

METHODS:

The authors recorded 695 bag-and-mask ventilations and 679 orotracheal intubations performed by 15 inexperienced interns during their 3 month-long anesthesia rotations. Learning curves for each procedure for each intern were constructed with both the standard and risk-adjusted cumulative sum methods. The average number of procedures required to attain a failure rate of 20% was estimated for each technique.

RESULTS:

Fourteen of 15 interns attained acceptable failure rates at bag-and-mask ventilation after 27 +/- 13 procedures, with a median (95% confidence interval) of 25 (15-32) procedures to cross the decision limit when considering all 15 interns. Nine of 15 interns attained acceptable failure rates at orotracheal intubation after 26 +/- 8 procedures, with a median of 29 (22-not estimable) procedures to cross the limit when considering all interns. The proportion of interns who attained acceptable failure rates for mask ventilation was greater than for tracheal intubation (93% vs. 60%, P = 0.025). Overall, our interns achieved a bag-and-mask ventilation failure rate of 20% or better after a median of 25 procedures; approximately 80% of interns achieved the goal after 35 procedures or less.

CONCLUSIONS:

Participating interns developed mask ventilation skills faster than orotracheal intubation skills, and there was more variability in the rate at which intubation skills developed. A median of 29 procedures was required to achieve an 80% orotracheal intubation success rate.

PMID:
20463580
DOI:
10.1097/ALN.0b013e3181d96779
[Indexed for MEDLINE]

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