Degrees of reality: airway anatomy of high-fidelity human patient simulators and airway trainers

Anesthesiology. 2012 Jun;116(6):1204-9. doi: 10.1097/ALN.0b013e318254cf41.


Background: Human patient simulators and airway training manikins are widely used to train airway management skills to medical professionals. Furthermore, these patient simulators are employed as standardized "patients" to evaluate airway devices. However, little is known about how realistic these patient simulators and airway-training manikins really are. This trial aimed to evaluate the upper airway anatomy of four high-fidelity patient simulators and two airway trainers in comparison with actual patients by means of radiographic measurements. The volume of the pharyngeal airspace was the primary outcome parameter.

Methods: Computed tomography scans of 20 adult trauma patients without head or neck injuries were compared with computed tomography scans of four high-fidelity patient simulators and two airway trainers. By using 14 predefined distances, two cross-sectional areas and three volume parameters of the upper airway, the manikins' similarity to a human patient was assessed.

Results: The pharyngeal airspace of all manikins differed significantly from the patients' pharyngeal airspace. The HPS Human Patient Simulator (METI®, Sarasota, FL) was the most realistic high-fidelity patient simulator (6/19 [32%] of all parameters were within the 95% CI of human airway measurements).

Conclusion: The airway anatomy of four high-fidelity patient simulators and two airway trainers does not reflect the upper airway anatomy of actual patients. This finding may impact airway training and confound comparative airway device studies.

MeSH terms

  • Adolescent
  • Adult
  • Airway Management
  • Anesthesiology / education*
  • Clinical Competence
  • Computer Simulation
  • Epiglottis / anatomy & histology
  • Epiglottis / diagnostic imaging
  • Female
  • Humans
  • Intubation, Intratracheal
  • Male
  • Manikins*
  • Middle Aged
  • Palate / anatomy & histology
  • Palate / diagnostic imaging
  • Pharynx / anatomy & histology
  • Pharynx / diagnostic imaging
  • Respiratory System / anatomy & histology*
  • Respiratory System / diagnostic imaging
  • Tomography, X-Ray Computed
  • Tongue / anatomy & histology
  • Tongue / diagnostic imaging
  • Young Adult