Table 2 Study characteristics and major findings of 3DP utilities in critical care
First Author, et al. | Sub-category | Research design | Method | Population | sample size | Key Findings | Critical care Involved |
|---|---|---|---|---|---|---|---|
Ho BHK et al. [16] | Bronchoscopy | Quasi experimenta | Qualitative evaluation of model by expert physicians using Likert questionnaire | resp physicians with over 6-years experience | 5 | The model was inexpensive, scored well with the experts, and provided an example of use of single stage printing of multi-material model which decreased production time. Next steps are to add vocal cords and changing the texture of the material to resemble human tissue. | No |
Bustamante S. et al. [17] | Bronchoscopy | Technical Report | Comparison of bronchoscopy footage of model to real anatomy by authors | NA | NA | Similar to real human bronchoscopy, inexpensive, provides variety of both normal and anatomical variants (early take off of the right bronchus) | No |
Al-Ramahi J. et al. [18] | Bronchoscopy | Technical report and Quasi experiment | Used formulas to create a model that replicated the hardness of tissue at different ages. Questionnaire and scale given to participants following trying the model | Otolaryngology staff and faculty | 10 | Produced a bronchoscopy model that was judged as accurate anatomically and simulated the change in tissue hardness as age changes. Provides an inexpensive, easy to replace model for training. Next step: adding humidification to the model to be more realistic. | No |
Hornung A. et al. [19] | Bronchoscopy | Technical Report | Authors looking at footage using rigid and flexible bronchoscopy in water immersion | NA | NA | Using the model immersed in water created a realistic simulation of bronchoscopy in patients by decreasing the light reflection normally seen in plastic models. | No |
Deboer E.M. et al. [20] | Bronchoscopy | Technical report and RCT | Model produced using silicone casing and color-coded lobes for feedback. RCT to determine improvement short and long term. | Pediatric residents and specialists | 28 resident and 6 physicians | RCT showed improvement in confidence, accuracy, and speed of bronchoscopy compared to control. Validated by experts as realistic. 43 to 250% cheaper than commercial models. | No |
Parotto M. at al [21]. | Bronchoscopy | Technical report and quasi experiment | Created an inexpensive low-fidelity model. Used a pretest/post-test and feedback form. | Intensive care residents | NR | Increase in confidence, decrease in time taken per practice, increased post test score after using the model. | Yes |
Ghazy A. et al. [22] | Bronchoscopy | Technical report and quasi experiment | Prototype for adult bronchoscopy was created. The time to complete task in sequential practices while removing in experienced vs novice users was measured. | cardiovascular residents | 10 | Simulator decreased time taken per each practice, increased proficiency for both groups, and was able to differentiate experienced from not. Both groups reached same level at the end. | No |
Pedersen T.H. et al. [23] | Bronchoscopy | RCT | VAS score of realism, anatomical accuracy, and time to achieve tasks were measured as participants tried the 3DP model vs. commercial model. | 18 anesthetists and 12 respirologists | 30 | 3DP model group had significantly better scores than commercial models in realism and was non inferior in time taken to achieve tasks like aspiration. However, bronchial blocking was better in the commercial model. | No |
Steinfort D.P. et al. [24] | Bronchoscopy | Quasi experiment | Conduct tests using validated mBSTAT tool of novice, intermediate and expert participants | 28 med students, 3 resp. residents, 7 ICU residents, 6 resp. physicians | 31 novice, 7 intermediate, 6 experts | 3DP model was able to clearly differentiate scores between the various levels of experience. Next steps are to increase realism. | Yes |
Costello J.P [25]. | CHD | quasi experiment | pretest/post-test using Likert scale before and after seminar and simulation using a 3DP model | 23 peds critical care residents | 23 | 3DP model was shown to increase knowledge acquisition, reporting, and CHD structural conceptualization. Used malleable material to enable opening up the model and using stitches. | Yes |
Olivieri L.J. et al. [26] | CHD | Quasi experiment | Likert questionnaire after session using 3DP models with open windows for inner anatomy. | 22 residents, 10 ancillary workers, 38 nurses | 70 | 3DP model increased confidence in management and understanding of anatomy especially in nurses. The increase was positively correlated to the difficulty of the case. | Yes |
Olivieri L.J. et al. [27] | CHD | quasi experiment | Likert questionnaire after session using 3D virtual models and comparing the data to the previous study | 19 physicians and 34 nurses | 53 | 3DP model was shown to have higher scores in increased confidence in management and hand off but was more expensive than virtual models. | Yes |
White S.C. et al. [28] | CHD | RCT | RCT comparing scores in a lecture only group vs lecture and model group for VSD and ToF | 26 pediatric and otolaryngology/emerg residents in VSD, 34 in ToF | 60 | Study showed an increase in scores on a board-like exam after both intervention with higher scores for the 3DP group on ToF but higher for lecture only group on VSD. | Yes |
Doucet G [29]. | Cricothyroidotomy | Technical Report | Created a cricothyroidotomy model and used repeated expert feedback to modify it | NA | NA | Used multiple filaments to recreate the different density of tissues. Experts approved of its ability to teach students the major steps in the process | Yes |
Hughes K.E [30]. | Cricothyroidotomy | Technical report and quasi experiment | Created a cricothyroidotomy model that is perfused with fake blood, used 3 experts’ feedback, and did a pilot study using a convenience sample | 52 EM docs | 52 | The model was reported to cause an improvement in confidence and the bleeding capability was rated as realistic. Next steps are to decrease the thickness of the outer membrane of the model and making the thyroid cartilage less obvious. | Yes |
Katayama et al. [31] | Cricothyroidotomy | Technical report and RCT | Made a model using CT data. Used RCT to compare conventional model to 3DP model with a post-test using a porcine model. | 52 residents | 52 | The results showed that the 3DP model was as efficacious as the conventional model but was much more inexpensive. | No |
Risler Z. et al. [32] | Medical Imaging | Technical report | Made a model of dislocated shoulder in silicon casing and used US to test realism | NA | NA | The model produced realistic images and allows to see the dislocation as well as the needle during simulation of needle aspiration. | Yes |
Javan R. et al. [33] | Medical Imaging | Technical Report | Made a model using various materials of different echogenicity and resonance to create a life like model of the neck for US and CT guided procedures | NA | NA | The model allows for training in thyroid and lymph node biopsies, internal jugular vein access, facet joint injections, and pain management interventions. Accurately presents different tissue densities. However, each part had to be fabricated separately. | No |
O’Reilly M.K [34]. | Medical Imaging | Technical report and quasi experiment | Created a high-fidelity model of femoral vessel with fake blood perfusion and a pulse. Used Likert scale questionnaire to judge it compared to other available models. | Interventional Radiology residents | 19 | The results showed that the model was realistic for both anatomical variant and diseased vessels. Scored higher than other models in realism. The feedback was used and they were able to modify the gelatin used to make it more stable and increase the compressibility of the venous system. | No |
Yates E. et al. [35] | Thoracotomy | Technical report and quasi experiment | Created a thoracotomy model and tested it on EM residents using before and after questionnaires | EM residents | 21 | The questionnaires showed that the 3DP model increased their confidence of performing the procedure. | Yes |
Bettega A.L. et al. [36] | Chest Tube Insertion | Technical report and RCT | Created a chest tube model and used medical students and pre/post questionnaires to assess. | Medical students | 49 | The study showed an increase in confidence equal to animal models. | Yes |
Estomba C.C. et al. [37] | Epistaxis | Technical report and quasi experiment | Made a multi-material model with pulsating blood vessels and used a post questionnaire to assess it. | EM and ENT residents | NR | The model received positive feedback from the residents for its realism. | Yes |
Park L. et al. [38] | Endotracheal intubation | Technical Report | Created a multi-material model to match the different tissue characteristics. | NA | NA | The model was feasible to make and inexpensive to produce. Nest steps for the model is to modify the trachea to increase its realism. | No |
Muwaffak Z. et al. [39] | Wound Care | Technical report | Used a mixture of polycaprolactone and copper, zinc or silver to create personalized dressings. Measured the dose released across multiple days and its effects on S. aureus cultures. | NA | NA | The model released its content for 72 h, was adaptable to any shape on the body, was successful in limiting S. aureus growth. | No |
Li J. et al. [40] | Splints | Technical report and quasi experiment | Used 3D scanner and an algorithm to create a personalized design of a splint with enough immobilization. | healthy volunteers | 5 | Successfully created personalized splints with minimal discomfort, good immobilization, fast rendition, made in 2–5 h. Next steps are to add Velcro straps to increase its flexibility to edema. | No |
Wu P-K. et al. [41] | Splints | Case study | 3D scanner used on a patient and printed splint for left arm immobilization after shoulder debridement. | patient | 1 | Using the splint was linked to increased healing speed, decreased swelling, and a faster recovery from surgery and infection. It was also of a similar price as traditional splint. However, it took 66 h to make. | No |
Gómez-Ramos J.J. et al. [42] | Patient monitor | Technical report and quasi experiment | 3D printed box with chemical reagents and connected to a smartphone. Compared to gold standard and on a volunteer undergoing physical activity. | Volunteer | 1 | Its measures were comparable to conventional lactate measure, showing that it can work in real time. | No |
Aguilera-Astudillo C. et al. [43] | Stethoscope | technical report and quasi experiment | 3D printed chest piece, a microphone, dongle and smartphone. Tried it on 4 patients. | Patients | 4 | Was able to pick up S1 and S2 on all four patients and record the sounds. Works great for rural areas and crowded emergency rooms. Next steps are to create an algorithm that processes the audio signals. | No |
Kim S-H. et al. [44] | Laryngoscope | Technical report and RCT | Created a 3DP ergonomic handle. Used an RCT measuring success rate, intubation time, and subjective ease score while using the 3DP handle or conventional handles. | med students | 40 | The 3DP handle group had improved intubation time, ease score, and decreased number of trials needed on difficult scenarios compared to conventional handle. | Yes |
Dinsmore M. et al. [45] | Laryngoscope | Technical Report | 3D printed a laryngoscope handle with 4 tiles producing light using the handler’s body heat. Measured the illumination produced and its decay speed. | NA | NA | The 3DP handle was able to produce 200 Lux for more than 2 min which allows for easy intubation on normal airways. Next steps are to improve the amount of light produced and its duration. | No |
Lee D.W. et al. [46] | Laryngoscope | Technical report and quasi experiment and RCT | 3D printed attachment for smartphone and AirTraq to allow airway inspection without looking into the AirTraq. RCT performed on students to determine effect on intubation time and success rate. Quasi experiment on patients to determine safety and ability to broadcast the procedure. | Patients and Volunteers | 40 volunteers and 30 patients | The results showed similar time to intubate and success rate between the model and the control. It was also used safely on all 30 patients. However, there was reported difficulty due to the need to manually zoom and the limitations caused by variability in bandwidth. | No |