Skip to main content
Top
Published in: Annals of Intensive Care 1/2018

Open Access 01-12-2018 | Research

Evaluation of emotional excitation during standardized endotracheal intubation in simulated conditions

Authors: Nicolas S. Marjanovic, Christelle Teiten, Nicola Pallamin, Erwan L’Her

Published in: Annals of Intensive Care | Issue 1/2018

Login to get access

Abstract

Objective

To assess how stressful conditions in endotracheal intubation could induct emotional excitation in a population of acute care physicians.

Materials and methods

Two situations were randomly tested: one in standard and easy intubation conditions the other under difficult conditions presumed to induce stress (monitoring alarms, manikin lying on the floor, difficult intubation). Emotional excitation was assessed using several physiological (cardiac patterns, electrodermal activity and eye-tracking) and psycho-cognitive patterns. Auto-evaluations of video recordings and mental workload were performed immediately after simulation.

Results

Significant physiological parameter modifications were observed under the stressful intubation conditions (SDNN 35 ± 15 vs. 42 ± 21; p = 0.035—AVNN 514 ± 94 vs. 548 ± 110; p < 0.0001). Emotional excitation was demonstrated to lead a higher mental workload (NASA-TLX = 39 ± 18 vs. 63 ± 15; p = 0.001), frustration and effort dimensions being its determinant components (p < 0.01). Video recording auto-evaluations depicted significant emotional excitation occurrence under the difficult conditions, with few differences according to the operator’s experience.

Conclusion

This study highlights the fact that a stress condition during ETI on a simulation model leads to an important emotional excitation as compared to the neutral condition.
Literature
1.
go back to reference Combes X, Wang HE, Kupas DF, Paris PM, Bates RR, Costantino JP, Yealy DM. Multivariate predictors of failed prehospital endotracheal intubation. Acad Emerg Med. 2003;10:717–24.CrossRef Combes X, Wang HE, Kupas DF, Paris PM, Bates RR, Costantino JP, Yealy DM. Multivariate predictors of failed prehospital endotracheal intubation. Acad Emerg Med. 2003;10:717–24.CrossRef
2.
go back to reference Health French Authority. Assessment and improvement of practices. Health simulation’s good practice; 2012. Health French Authority. Assessment and improvement of practices. Health simulation’s good practice; 2012.
4.
go back to reference Bond WF, Deitrick LM, Arnold DC. Using simulation to instruct emergency medicine residents in cognitive forcing strategies. Acad Med. 2004;79:438–46.CrossRefPubMed Bond WF, Deitrick LM, Arnold DC. Using simulation to instruct emergency medicine residents in cognitive forcing strategies. Acad Med. 2004;79:438–46.CrossRefPubMed
5.
go back to reference Daglius Dias R, Scalabrini Neto A. Stress levels during emergency care: a comparison between reality and simulated scenarios. J Crit Care. 2016;33:8–13.CrossRefPubMed Daglius Dias R, Scalabrini Neto A. Stress levels during emergency care: a comparison between reality and simulated scenarios. J Crit Care. 2016;33:8–13.CrossRefPubMed
6.
go back to reference Berntson GG, Bigger JT Jr, van der Molen MW. Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology. 1997;34:623–48.CrossRefPubMed Berntson GG, Bigger JT Jr, van der Molen MW. Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology. 1997;34:623–48.CrossRefPubMed
7.
go back to reference Guidelines heart rate variability standards of measurement, physiological interpretation, and clinical use task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996;17:354–81. Guidelines heart rate variability standards of measurement, physiological interpretation, and clinical use task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996;17:354–81.
8.
go back to reference Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan RA, Pizzinelli P, et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res. 1986;59:178–93.CrossRefPubMed Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan RA, Pizzinelli P, et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res. 1986;59:178–93.CrossRefPubMed
9.
go back to reference Braithwaite JJ, Watson DG, Jones R, Rowe M. A guide for analysing electrodermal activity (EDA) and skin conductance responses (SCRs) for psychological experiments. Psychophysiology. 2015;49:1017–34. Braithwaite JJ, Watson DG, Jones R, Rowe M. A guide for analysing electrodermal activity (EDA) and skin conductance responses (SCRs) for psychological experiments. Psychophysiology. 2015;49:1017–34.
10.
go back to reference Boucsein W, Fowles DC, Grimnes S, Ben Shakhar G, Roth WT, Dawson ME, Filion DL. Publication recommendations for electrodermal measurements. Psychophysiology. 2012;49:1017–34.CrossRefPubMed Boucsein W, Fowles DC, Grimnes S, Ben Shakhar G, Roth WT, Dawson ME, Filion DL. Publication recommendations for electrodermal measurements. Psychophysiology. 2012;49:1017–34.CrossRefPubMed
11.
go back to reference Mele ML, Federici S. Gaze and eye-tracking solutions for psychological research. Cogn Process. 2012;13:261–5.CrossRef Mele ML, Federici S. Gaze and eye-tracking solutions for psychological research. Cogn Process. 2012;13:261–5.CrossRef
12.
go back to reference NASA Task Load Index (TLX) V 1.0 users manual, Human Systems Information Analysis Center; 1988. NASA Task Load Index (TLX) V 1.0 users manual, Human Systems Information Analysis Center; 1988.
13.
go back to reference Hart SG, Staveland LE. Development of NASA-TLX (task load index): results of experimental and theoretical research. Hum Ment Workload. 1988;52:139–83.CrossRef Hart SG, Staveland LE. Development of NASA-TLX (task load index): results of experimental and theoretical research. Hum Ment Workload. 1988;52:139–83.CrossRef
14.
go back to reference Wetzel CM, Black SA, Hanna GB, Athanasiou T, Kneebone RL, Nestel D, Wolfe JH, Woloshynowych M. The effects of stress and coping on surgical performance during simulations. Ann Surg. 2010;25(1):171–6.CrossRef Wetzel CM, Black SA, Hanna GB, Athanasiou T, Kneebone RL, Nestel D, Wolfe JH, Woloshynowych M. The effects of stress and coping on surgical performance during simulations. Ann Surg. 2010;25(1):171–6.CrossRef
15.
go back to reference Kohn LT, Corrigan JM, Donaldson MS, editors. Institute of Medicine (US) Committee on Quality of Health Care in America. To err is human: building a safer health system. Washington, DC: National Academies Press (US); 2000. Kohn LT, Corrigan JM, Donaldson MS, editors. Institute of Medicine (US) Committee on Quality of Health Care in America. To err is human: building a safer health system. Washington, DC: National Academies Press (US); 2000.
16.
go back to reference Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R. The impact of stress on surgical performance: a systematic review of the literature. Surgery. 2010;147:318–30.CrossRefPubMed Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R. The impact of stress on surgical performance: a systematic review of the literature. Surgery. 2010;147:318–30.CrossRefPubMed
17.
go back to reference Mills B, Carter O, Rudd C, Claxton L, O’Brien R. An experimental investigation into the extent social evaluation anxiety impairs performance in simulation-based learning environments amongst final-year undergraduate nursing students. Nurse Educ Today. 2016;45:9–15.CrossRefPubMed Mills B, Carter O, Rudd C, Claxton L, O’Brien R. An experimental investigation into the extent social evaluation anxiety impairs performance in simulation-based learning environments amongst final-year undergraduate nursing students. Nurse Educ Today. 2016;45:9–15.CrossRefPubMed
18.
go back to reference Rieger A, Stoll R, Kreuzfeld S, Behrens K, Weippert M. Heart rate and heart rate variability as indirect markers of surgeons’ intraoperative stress. Int Arch Occup Environ Health. 2014;87:165–74.CrossRefPubMed Rieger A, Stoll R, Kreuzfeld S, Behrens K, Weippert M. Heart rate and heart rate variability as indirect markers of surgeons’ intraoperative stress. Int Arch Occup Environ Health. 2014;87:165–74.CrossRefPubMed
19.
go back to reference Horsten M, Ericson M, Perski A, Wamala SP, Schenck-Gustafsson K, Orth-Gomér K. Psychosocial factors and heart rate variability in healthy women. Psychosom Med. 1999;61:49–57.CrossRefPubMed Horsten M, Ericson M, Perski A, Wamala SP, Schenck-Gustafsson K, Orth-Gomér K. Psychosocial factors and heart rate variability in healthy women. Psychosom Med. 1999;61:49–57.CrossRefPubMed
20.
go back to reference Myrtek M, Weber D, Brugner G, Muller W. Occupational stress and strain of female students:results of physiological, behavioural, and psychological monitoring. Biol Psychol. 1996;42:379–91.CrossRefPubMed Myrtek M, Weber D, Brugner G, Muller W. Occupational stress and strain of female students:results of physiological, behavioural, and psychological monitoring. Biol Psychol. 1996;42:379–91.CrossRefPubMed
21.
go back to reference Brosschot JF, Van Dijk E, Thayer JF. Daily worry is related to low heart rate variability during waking and the subsequent nocturnal sleep period. Int J Phychophysiol. 2007;63:39–47.CrossRef Brosschot JF, Van Dijk E, Thayer JF. Daily worry is related to low heart rate variability during waking and the subsequent nocturnal sleep period. Int J Phychophysiol. 2007;63:39–47.CrossRef
22.
go back to reference Clays E, De Bacquer D, Crasset V, et al. The perception of work stressors is related to reduced parasympathetic activity. Int Arch Occup Environ Health. 2011;84:185–91.CrossRefPubMed Clays E, De Bacquer D, Crasset V, et al. The perception of work stressors is related to reduced parasympathetic activity. Int Arch Occup Environ Health. 2011;84:185–91.CrossRefPubMed
23.
go back to reference Delaney JPA, Brodie DA. Effects of short-term psychological stress on the time and frequency domains of heart-rate variability. Percept Mot Skills. 2000;91:515–24.CrossRefPubMed Delaney JPA, Brodie DA. Effects of short-term psychological stress on the time and frequency domains of heart-rate variability. Percept Mot Skills. 2000;91:515–24.CrossRefPubMed
24.
go back to reference Naveteur J, Buisine S, Gruzelier JH. The influence of anxiety on electrodermal responses to distractors. Int J Psychophysiol. 2005;56:261–9.CrossRefPubMed Naveteur J, Buisine S, Gruzelier JH. The influence of anxiety on electrodermal responses to distractors. Int J Psychophysiol. 2005;56:261–9.CrossRefPubMed
25.
26.
go back to reference Figner B, Murphy RO. Using skin conductance in judgment and decision making research. In: Schulte-Mecklenbeck M, Kuehberger A, Ranyard R, editors. A handbook of process tracing methods for decision research. New York: Psychology Press; 2011. Figner B, Murphy RO. Using skin conductance in judgment and decision making research. In: Schulte-Mecklenbeck M, Kuehberger A, Ranyard R, editors. A handbook of process tracing methods for decision research. New York: Psychology Press; 2011.
27.
go back to reference Just MA, Carpenter PA. Eye fixations and cognitive processes. Cogn Psychol. 1976;8:441–80.CrossRef Just MA, Carpenter PA. Eye fixations and cognitive processes. Cogn Psychol. 1976;8:441–80.CrossRef
28.
go back to reference Williams B, Quested A, Cooper S. Can eye-tracking technology improve situational awareness in paramedic clinical education? OAEM. 2013;5:23–8.CrossRefPubMed Williams B, Quested A, Cooper S. Can eye-tracking technology improve situational awareness in paramedic clinical education? OAEM. 2013;5:23–8.CrossRefPubMed
29.
go back to reference Herten N, Otto T, Wolf OT. The role of eye fixation in memory enhanced under stress—an eye tracking study. Neurobiol Learn Mem. 2017;140:134–44.CrossRefPubMed Herten N, Otto T, Wolf OT. The role of eye fixation in memory enhanced under stress—an eye tracking study. Neurobiol Learn Mem. 2017;140:134–44.CrossRefPubMed
30.
go back to reference Schulz CM, Schneider E, Schneider G. Visual attention of anaesthetists during simulated critical incidents. Br J Anaesth. 2011;106:807–13.CrossRefPubMed Schulz CM, Schneider E, Schneider G. Visual attention of anaesthetists during simulated critical incidents. Br J Anaesth. 2011;106:807–13.CrossRefPubMed
31.
go back to reference Chajut ED, Algom D. Selective attention improves under stress: implications for theories of social cognition. J Per Soc Psychol. 2003;85:231–48.CrossRef Chajut ED, Algom D. Selective attention improves under stress: implications for theories of social cognition. J Per Soc Psychol. 2003;85:231–48.CrossRef
32.
go back to reference Christianson SA, Loftus EF, Hoffman H, Loftus GR. Eye fixations and memory for emotional events. J Exp Psychol Learn Mem Cogn. 1991;17:693–701.CrossRefPubMed Christianson SA, Loftus EF, Hoffman H, Loftus GR. Eye fixations and memory for emotional events. J Exp Psychol Learn Mem Cogn. 1991;17:693–701.CrossRefPubMed
33.
go back to reference Loftus GR. Eye fixations and recognition memory for pictures. Cogn Psychol. 1972;3:525–51.CrossRef Loftus GR. Eye fixations and recognition memory for pictures. Cogn Psychol. 1972;3:525–51.CrossRef
34.
35.
go back to reference Yerkes R, Dodson J. The relation of strength of stimulus to rapidity of habit-formation. J Comp Neurol Psychol. 1908;18:459–82.CrossRef Yerkes R, Dodson J. The relation of strength of stimulus to rapidity of habit-formation. J Comp Neurol Psychol. 1908;18:459–82.CrossRef
Metadata
Title
Evaluation of emotional excitation during standardized endotracheal intubation in simulated conditions
Authors
Nicolas S. Marjanovic
Christelle Teiten
Nicola Pallamin
Erwan L’Her
Publication date
01-12-2018
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2018
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-018-0460-0

Other articles of this Issue 1/2018

Annals of Intensive Care 1/2018 Go to the issue