Novice And Expert Muscle Utilization And Wrist Postures During Simulated Endotrachial Intubation – A Pilot Study

Abstract

Endotracheal Intubation (ETI) is an airway procedure commonly used to secure the airway for a variety of medical conditions. Endotracheal tube placement is most commonly performed under direct vision of the glottis with the use of a standard laryngoscope and blade. Proficiency in ETI procedures requires significant clinical experience and insufficient data currently exists describing the physical ergonomics of successful direct laryngoscopy. The research objectives of this study were to examine how ETI time, error and practitioner biomechanics varied among clinical experience levels and hospital bed heights. The participant population included novice and expert subgroups recruited from the University of Nebraska Medical Center, and the department of Emergency Medicine. Using a standard laryngoscope handle and blade, participants performed ETI trials on an airway manikin trainer at a minimum and maximum bed height. Participants were evaluated based on ETI completion time, endotracheal tube placement, wrist postures and technique errors. Task completion time and ETI errors did not vary with hospital bed height. Muscle utilization did not differ significantly between bed heights or expert and novice participants. Experts exhibited greater wrist extension and less ulnar deviation during task trials. Expert participants grasped the laryngoscope differently than novice participants, resulting in less wrist manipulation required to achieve ideal instrument positions. By encouraging ideal hand and arm postures during ETI training and simulation, the opportunity exists to improve patient safety and reduce the significant learning curve associated with ETI procedures.