Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942009000300007
Brazilian Journal of Anesthesiology
Scientific Article

Aplicação da curva CUSUM para avaliar o treinamento da intubação orotraqueal com o laringoscópio Truview EVO2®

Using the Cusum curve to evaluate the training of orotracheal intubation with the Truview EVO2® laryngoscope

Jaqueline Betina Broenstrup Correa; José Ernani Flores Dellazzana; Alexandre Sturm; Dante Moore Almeida Leite; Getúlio Rodrigues de Oliveira Filho; Rogério Gastal Xavier

http://dx.doi.org/10.1590/S0034-70942009000300007 Braz J Anesthesiol, vol.59, n3, p.321-331, 2009
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Resumo

JUSTIFICATIVA E OBJETIVOS: As curvas de aprendizado têm se mostrado ferramentas úteis no monitoramento do desempenho de um trabalhador submetido a uma nova tarefa. Essas curvas vêm sendo utilizadas na avaliação de vários procedimentos na prática médica. O objetivo desta pesquisa foi avaliar o aprendizado da intubação orotraqueal (IOT) com o laringoscópio Truview EVO2® através da curva de aprendizado CUSUM. MÉTODO: Quatro aprendizes realizaram o treinamento da IOT com o laringoscópio Truview EVO2® em manequim. Eles foram orientados quanto aos critérios de sucesso e falha na IOT e alternaram-se nas tentativas, num total de 300 IOT para cada um deles. Quatro curvas de aprendizado foram construídas a partir do método da soma cumulativa CUSUM. RESULTADOS: O número calculado para adquirir proficiência na tarefa foi de 105 IOT. Os quatro aprendizes cruzaram a linha de taxa de falha aceitável de 5% antes de completar 105 IOT: o primeiro aprendiz alcançou a faixa de proficiência após 42 IOT, o segundo e o terceiro aprendizes, após 56 IOT, e o quarto aprendiz, após 97 IOT, mantendo-se constantes em seus desempenhos a partir de então. Não houve diferença na taxa de sucesso entre residentes e anestesiologistas experientes. CONCLUSÕES: A curva de aprendizado CUSUM é um instrumento útil para demonstração objetiva de habilidade na execução de uma nova tarefa. A laringoscopia com o Truview EVO2® em manequim demonstrou ser um procedimento fácil para médicos com experiência prévia em IOT, porém, a transposição dos resultados para a prática clínica deve ser cautelosa.

Palavras-chave

ANESTESIOLOGIA, Ensino, INTUBAÇÃO TRAQUEAL

Abstract

BACKGROUND AND OBJECTIVES: Learning curves have proved to be useful tools to monitor the performance of a worker on a new assignment. Those curves have been used to evaluate several medical procedures. The objective of this study was to evaluate the learning of orotracheal intubation (OTI) with the Truview EVO2® laryngoscope with the CUSUM learning curve. METHODS: Four trainees underwent OTI training with the Truview EVO2® laryngoscope in a mannequin. They received orientation on the successful and failure criteria of OTI and alternated during the attempts, for a total of 300 OTI for each one. Four learning curves were plotted using the CUSUM cumulative addition method. RESULTS: It was calculated that the 105 OTIs were necessary to achieve proficiency. The four trainees crossed the line of acceptable failure rate of 5% before completing 105 OTIs; the first trainee reached proficiency after 42 OTIs, the second and third after 56 OTIs, and the fourth after 97 OTIs, and from then on their performance remained constant. Differences in the success rate between residents and experienced anesthesiologists were not observed. CONCLUSIONS: The CUSUM learning curve is a useful instrument to demonstrate objectively the ability when performing a new task. Laryngoscopy with the Truview EVO2® in a mannequin proved to be an easy procedure for physicians with prior experience in OTI; however, one should be cautious when transposing those results to clinical practice.

Keywords

ANESTHESIOLOGY, Teaching, TRACHEAL INTUBATION

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