Torben Becker, MD, PhD
Chief, Division of Critical Care Medicine
Shands Hospital - University of Florida
Gainesville, Florida
Disclosure information not submitted.
Lindsay Beamon-Scott, MD
Assistant Professor
University of Rochester, United States
Disclosure information not submitted.
Gordon Darant, MD
Attending Physician
Bernard Mevs Hospital
Port-au-Prince, Haiti
Disclosure information not submitted.
Stacy House, RRT
Respiratory Therapist
Hopital Bernard Mevs
Port-au-Prince, Haiti
Disclosure information not submitted.
Jerry Bitar, MD
Medical Director
Hopital Bernard Mevs
Port-au-Prince, Haiti
Disclosure information not submitted.
Marlon Bitar, MD
Medical Director
Hopital Bernard Mevs
Port-au-Prince, Haiti
Disclosure information not submitted.
Title: A simplified approach to bronchoscopy training in low-resource environment
Case Report Body
Introduction: Bronchoscopy is an essential procedure in the intensive care unit (ICU). The procedure requires a certain degree of dexterity that cannot be easily learned without hands-on practical experience. At the same time, bronchoscopy can be associated with patient discomfort and injuries if performed by an inexperienced clinician. In Haiti, few hospitals are capable of providing advanced critical care services. The Hôpital Bernard Mevs (HBM) is a trauma & critical care center in Port-au-Prince with a dedicated six bed ICU. Mucus plugging is a frequently seen complication in patients intubated for prolonged periods of time, despite external chest physiotherapy and respiratory care by a respiratory therapist.
Description: In May 2021, HBM introduced bronchoscopy to its ICU with an Ambu Ascope 3 system. However, ICU physicians had not previously been trained in bronchoscopy. Therefore, we developed a simplified task trainer. An old cardiopulmonary resuscitation manikin was disassembled, and the coil for chest compressions removed. The manikin was ‘orotracheally’ intubated, and polyvinyl chloride pipes connected via joints were placed into the empty ‘chest’ cavity (Figure 1). The pipes were spray-painted with orange paint on the inside, which created a near-real impression of mucosal color and texturing on the bronchoscope monitor. The system was then used to train four Haitian physicians in the general use and principles of the bronchoscope and for practice of dexterity (Figure 2).
Discussion: In recent years, sparse critical care services have become available in low-income countries such as Haiti. While lifesaving for many patients, clinicians in these settings face new challenges and complications seen in critically ill patients, such as mucus plugging in patients intubated for prolonged periods of time. Bronchoscopy, as all procedures, requires training. However, traditional bronchoscopy task trainers are expensive and large, making their use in resource-limited settings unlikely. Our simplified task trainer allowed ICU physicians in Haiti to practice the basic skills of bronchoscopy in a safe environment. Future refinements will include construction of a task trainer with more realistic bronchial anatomy.