An active high fidelity simulator device for newborn respiratory care: A multidisciplinary experience

Neonatal endotracheal intubation is a complex procedure because of the complex newborn’s airway anatomy. Excessive pressure on soft tissues during laryngoscopy can determine permanent damage, even during expert performance. Commercial passive skill trainers do not give valid feedback about this problem. The present study describes the engineering design and clinical assessment of an active neonatal skills and assessment trainer providing objective feedback during intubation manoeuvres. The most appropriate technical solutions for a proper sensorization methodology able to follow both the medical requirements and engineering constraints were identified. Commercial force sens ors were fixed on a ©Laerdal Neonatal Intubation Trainer in the areas that are mostly subject to pressure and potential damages (epiglottis and dental arches). Additionally, an home-madepolymeric tongue was designed to integrate a matrix textile sensor for pressure mapping. An associated software provides real time sound feedback if pressure during laryngoscopy exceeds an established threshold. Pressure data are continuously recorded and exported in a database for subsequent analysis. Data examination from training sessions shown that the mainly stressed area is the epiglottis while the investigation performed on the tongue pressure provided both force values and distribution, in agreement with clinicians' performance. The proposed skill trainer represents a reliable model of intubation and the obtained results show its potential to optimize procedures related to the control of trauma risk and to improve personnel retraining.