Management of Malpositioned Double-Lumen Tubes: A Simulation-Based Training Exercise for Anesthesiology Residents

Abstract

Objectives: Demonstrate the feasibility and effectiveness of using the AirSim® Bronchi airway simulator to teach anesthesia residents how to successfully troubleshoot and manage malpositioned double-lumen endotracheal tubes used for single-lung ventilation. Design: Prospective observational study. Setting: Simulation lab in a university-based anesthesiology residency training program. Participants: CA1 (PGY2) anesthesiology residents. Interventions: Each resident was initially tasked with troubleshooting a malpositioned double-lumen tube (DLT) on an AirSim® Bronchi (Trucorp, Craigavon, UK) airway simulator in one of the three positions and was timed on their performance. This first simulation was followed by completion of a survey that assessed the resident’s level of confidence in repositioning a malpositioned DLT. Following the initial simulation, a didactic presentation was given to the residents on the management of malpositioned DLTs using a protocol, followed by a practice session. Two months later, each resident repeated the simulation exercise. A follow-up survey was conducted after each simulation, assessing the quality of the curriculum and subsequent level of confidence in performing the same tasks using a five-point Likert scale. Measurements and Main Results: Ten residents at the University of Mississippi Medical Center completed the simulation exercises and curriculum. The average time it took to troubleshoot the malpositioned DLT during the first simulation was 139 s, with only 30% of the residents correctly identifying the specific malposition and 40% correctly repositioning the DLT after initial malposition. The repeat simulation after two months showed significant improvement in efficiency, with the average time to complete the task decreasing from 139 s to 56 s. During the second simulation exercise, all 10 residents were able to correctly identify the DLT malposition and correctly reposition the DLT to the correct position. Additionally, residents’ confidence levels in managing a malpositioned DLT improved significantly. Initially, 70% of the residents reported a lack of confidence in identifying and correcting a malpositioned DLT, but after the didactic curriculum and simulation training, 100% of the residents reported confidence in completing the task. Conclusions: The AirSim® Bronchi (Trucorp, Craigavon, UK) simulator can be used to effectively teach and evaluate residents on correctly identifying and repositioning a malpositioned DLT. The residents’ performance and level of confidence were evaluated before and after the simulation curriculum. The results reveal that simulation-based training is an effective educational tool for improving clinical performance and confidence in identifying and appropriately managing a malpositioned DLT.