Impact d’un module d’enseignement de la sédation procédurale, basé sur la simulation à haute fidélité, sur la performance des résidents non- anesthésiologistes pour la prise en charge des complications respiratoires liées à la sédation : étude prospective, randomisée en simple insu
A Hi-Fi simulation-based sedation course improves the performance of non-anesthesiology residents for the management of airway complications, compared with self-learning.  A randomized, controlled, single blinded trial.  Background: Sedation is a depression of consciousness ranging from anxiolysis to something less than general anesthesia. It is used by non-anesthesiologists to facilitate stressful or painful diagnostic tests and minor surgeries. The primary complications of procedural sedation impact the airway and respiratory system. Early diagnosis and adequate management of airway complications may prevent negative outcomes such as hypoxic brain damage or death. We investigated whether a simulation-based sedation course improved the performance of non-anesthesiology residents for the management of airway and respiratory complications during sedation, compared with self-learning. Methods: Thirty-two residents, without prior airway management experience, underwent a pre-test revolving around a HI-FI scenario of a complicated procedural sedation case. Residents were subsequently randomized to either attend an oriented debriefing including a theoretical course and a practical workshop with a low fidelity mannequin (Group E) or to simply view a video on sedation management (group C). A post-test that included a different sedation Hi-Fi scenario with airway complication, was carried out 21 days later. All scenarios were adapted to include realistic elements for all students from the various participating specialties. Residents’ performance was assessed by two evaluators who viewed the recorded scenarios without knowledge of the order in which they were conducted or of the participants’ group. It was rated according to a pre-established performance grid that was developed by simulation experts using the Delphi technique. The results are compared by a Wilcoxon rank test, or by a Mann-Whitney rank test.  Results: A significant improvement in performance was noted by both evaluators in group E (Evaluator A: 14,31∓2,30 vs 17,00∓1,59. Evaluator B: 12,38 ∓1,96 vs 14,94∓1,48. p<0.0001). A slight performance improvement was also noted in the control group, but this was not statistically significant (Evaluator A: 14,63∓1,40 vs 15,81∓1,79. Evaluator B: 13,31∓2,21 vs 14,75∓1,88). There was a significant positive correlation between the results of the evaluators. Conclusion : Our sedation crash course, based mainly on high-fidelity simulation, has allowed non-anesthesiology residents to improve their performance, and provided them with a safe way of managing procedural sedation and related airway and respiratory complications, compared to self-learning.
high-fidelity simulation sedation simulation based medical education