Secondary Logo

Institutional members access full text with Ovid®

The effect of virtual reality bronchoscopy simulator training on performance of bronchoscopic-guided intubation in patients

A randomised controlled trial

Wong, David T.; Mehta, Arpan; Singh, Kawal P.; Leong, Siaw M.; Ooi, Alister; Niazi, Ahtsham; You-Ten, Eric; Okrainec, Allan; Patel, Rajesh; Singh, Mandeep; Wong, Jean

European Journal of Anaesthesiology (EJA): March 2019 - Volume 36 - Issue 3 - p 227–233
doi: 10.1097/EJA.0000000000000890
Airway management

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.


From the Department of Anaesthesia, Toronto Western Hospital, Toronto, Ontario, Canada (DTW, KPS, AN, AO, RP, MS, JW), Department of Anaesthesia, University College, London Hospitals, London, UK (AM), Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (SML), Department of Anaesthesia, John Fawkner Hospital, Coburg, Victoria, Australia (AO) and Department of Anaesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada (EY-T)

Correspondence to David T. Wong, Department of Anaesthesia, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 Tel: +1 416 603 5118; e-mail:

Published online 17 September 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

© 2019 European Society of Anaesthesiology