Impact of a custom-made 3D printed ergonomic grip for direct laryngoscopy on novice intubation performance in a simulated easy and difficult airway scenario-A manikin study

Advancements in additive manufacturing for video laryngoscopes: a comprehensive scoping and technological review

The global healthcare crisis with the COVID-19 pandemic has placed a significant overwhelming demand for intubation procedures and the need for reliable and accessible video laryngoscopes. The purpose of this scoping and technological review is to provide a comprehensive overview of the current state of the art, covering the period from 2007 to 2022, pertaining to the manufacturing process, characteristics, and validation of video laryngoscopes produced using additive manufacturing techniques. Following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), an exhaustive search was conducted across nine prominent databases (PubMed, Web of Science, Scopus, Cochrane, Prospero, Scielo, Embase, Lilacs, Virtual Health Libraries-VHL) and four patent databases (EPO/ESPACENET, WIPO/PATENTSCOPE, National Institute of Industrial Property (INPI), Google Patents). The main materials utilized for the impression, as well as the physical characteristics of the device are introduced at first. Crucial aspects to facilitate proper visualization of the anatomical structures during endotracheal intubation as the optimal angulation of the blade, the mechanical resistance of the device, traction force on the jaw, intubation time, and the experimental methods employed to validate its performance were reviewed in terms of their recent advances.

Applications of 3D printing in critical care medicine: A scoping review

Although a wide range of medical applications for three-dimensional printing technology have been recognised, little has been described about its utility in critical care medicine. The aim of this review was to identify three-dimensional printing applications related to critical care practice. A scoping review of the literature was conducted via a systematic search of three databases. A priori specified themes included airway management, procedural support, and simulation and medical education. The search identified 1544 articles, of which 65 were included. Ranging across many applications, most were published since 2016 in non - critical care discipline-specific journals. Most studies related to the application of three-dimensional printed models of simulation and reported good fidelity; however, several studies reported that the models poorly represented human tissue characteristics. Randomised controlled trials found some models were equivalent to commercial airway-related skills trainers. Several studies relating to the use of three-dimensional printing model simulations for spinal and neuraxial procedures reported a high degree of realism, including ultrasonography applications three-dimensional printing technologies. This scoping review identified several novel applications for three-dimensional printing in critical care medicine. Three-dimensional printing technologies have been under-utilised in critical care and provide opportunities for future research.

3D printing in critical care: a narrative review

BACKGROUND

3D printing (3DP) has gained interest in many fields of medicine including cardiology, plastic surgery, and urology due to its versatility, convenience, and low cost. However, critical care medicine, which is abundant with high acuity yet infrequent procedures, has not embraced 3DP as much as others. The discrepancy between the possible training or therapeutic uses of 3DP in critical care and what is currently utilized in other fields needs to be addressed.

OBJECTIVE

This narrative literature review describes the uses of 3DP in critical care that have been documented. It also discusses possible future directions based on recent technological advances.

METHODS

A literature search on PubMed was performed using keywords and Mesh terms for 3DP, critical care, and critical care skills.

RESULTS

Our search found that 3DP use in critical care fell under the major categories of medical education (23 papers), patient care (4 papers) and clinical equipment modification (4 papers). Medical education showed the use of 3DP in bronchoscopy, congenital heart disease, cricothyroidotomy, and medical imaging. On the other hand, patient care papers discussed 3DP use in wound care, personalized splints, and patient monitoring. Clinical equipment modification papers reported the use of 3DP to modify stethoscopes and laryngoscopes to improve their performance. Notably, we found that only 13 of the 31 papers were directly produced or studied by critical care physicians.

CONCLUSION

The papers discussed provide examples of the possible utilities of 3DP in critical care. The relative scarcity of papers produced by critical care physicians may indicate barriers to 3DP implementation. However, technological advances such as point-of-care 3DP tools and the increased demand for 3DP during the recent COVID-19 pandemic may change 3DP implementation across the critical care field.

Patient-specific and hyper-realistic phantom for an intubation simulator with a replaceable difficult airway of a toddler using 3D printing

Difficult tracheal intubation is the third most common respiratory-related adverse co-morbid episode and can lead to death or brain damage. Since difficult tracheal intubation is less frequent, trainees have fewer opportunities to perform difficult tracheal intubation; this leads to the need to practice with a hyper-realistic intubation simulator. However, conventional simulators are expensive, relatively stiffer than the human airway, and have a lack of diversity in terms of disease variations and anatomic reproducibility. Therefore, we proposed the development of a patient-specific and hyper-realistic difficult tracheal intubation simulator using three-dimensional printing technology and silicone moulding and to test the feasibility of patient-specific and hyper-realistic difficult intubation simulation using 3D phantom for the trainee. This difficult tracheal intubation phantom can provide a realistic simulation experience of managing various difficult tracheal intubation cases to trainees, which could minimise unexpected tissue damage before anaesthesia. To achieve a more realistic simulation, a patient-specific phantom was fabricated to mimic human tissue with realistic mouth opening and accurate difficult airway shape. This has great potential for the medical education and training field.

Endotracheal Intubation by Paramedics Using Neodymium Magnet and Modified Stylet in Simulated Difficult Airway: A Prospective, Randomized, Crossover Manikin Study

BACKGROUND

The present study evaluates the success and efficacy of endotracheal intubation (ETI) using a modified intubation stylet and a magnet system to direct the stylet into the trachea. The system was developed by the researchers in an attempt to increase the success and efficacy of ETI.

METHODS

ETI procedures were performed on an airway management manikin by emergency medical technicians with at least four years of experience in ETI. The technicians used a stylet modified with an iron ball affixed to the tip and a neodymium magnet, designed specifically for the study. The intention was to guide the endotracheal tube into the trachea at the level of the thyroid and cricoid cartilages on the manikin with the aid of the modified stylet and the magnetic force of the neodymium magnet. The success rate, completion time, and degree of difficulty of two procedures were compared: magnetic endotracheal intubation (METI) and classic ETI (CETI).

RESULTS

The success rate was 100% in both groups. The mean completion times for the METI and CETI procedures were 18.31 ± 2.46 s and 20.01 ± 1.95 s, respectively. There were significant differences in completion time and degree of difficulty between the METI and CETI procedures (both p=0.001).

CONCLUSIONS

We found the use of a neodymium magnet and modified stylet to be an effective method to guide the endotracheal tube into the trachea. The present study may provide a basis for future studies.