The effect of virtual reality bronchoscopy simulator training on performance of bronchoscopic-guided intubation in patients: A randomised controlled trial

Eur J Anaesthesiol. 2019 Mar;36(3):227-233. doi: 10.1097/EJA.0000000000000890.


Background: The use of a flexible optical bronchoscopic (FOB) for intubation is an essential airway management skill.

Objective(s): Our primary objective was to compare the effects of simulator training (ORSIM high-fidelity simulator) with no simulation training on the performance of FOB intubation in anaesthetised patients.

Design: Randomised controlled trial.

Setting: Single-centre tertiary hospital; trial conducted between April 2015 to May 2016.

Participants: Medical students, anaesthesia assistants and anaesthesia residents with experience of less than five FOB intubations from whom informed consent was obtained.

Intervention: Students, anaesthesia assistants and anaesthesia residents viewed a didactic presentation before performing an initial FOB intubation in an anaesthetised patient. Intubations were recorded and evaluated using the Global Rating Scale (GRS) and checklist scores. Subsequently, participants were randomised to control group (Group CON) and had no simulation training, or to a simulation group (Group SIM) and underwent 60 min of simulation practice. Within a week, participants performed a second FOB intubation and were similarly evaluated.

Main outcome measures: Pretraining and posttraining intubation time, GRS and checklist scores.

Results: Baseline characteristics were similar between groups. In Group SIM, there was significant improvement between pre and posttraining GRS [22.9 ± 8.1 vs. 28.2 ± 7.3, mean difference (95% CI) 5.3 (0.3 to 10.3), P = 0.04], and intubation time [177.6 ± 77.6 vs. 119.3 ± 52.2 s, mean difference (95% CI) -58.4 (-100.3 to -16.5) s, P = 0.01]. There was no difference in Group CON, between pre and posttraining intubation time, GRS or checklist.

Conclusion: We conclude, posttraining performance of FOB intubation, as measured by intubation time and GRS, improved in Group SIM, while it was unchanged in the Group CON. The ORSIM simulator may be a useful adjunct in acquiring FOB intubation skills.

Clinical trial number and registry: ID: NCT02699242.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anesthetists / standards
  • Bronchoscopes*
  • Bronchoscopy / instrumentation
  • Bronchoscopy / methods*
  • Clinical Competence / standards*
  • Female
  • Humans
  • Internship and Residency / standards
  • Intubation, Intratracheal / instrumentation
  • Intubation, Intratracheal / methods*
  • Male
  • Middle Aged
  • Students, Medical
  • Virtual Reality*

Associated data