title: Degrees of reality: airway anatomy of high-fidelity human patient simulators and airway trainers.
abstract: BACKGROUND
  Human patient simulators and airway training manikins are widely used to train airway management skills to medical professionals. Furthermore, these patient simulators are employed as standardized "patients" to evaluate airway devices. However, little is known about how realistic these patient simulators and airway-training manikins really are. This trial aimed to evaluate the upper airway anatomy of four high-fidelity patient simulators and two airway trainers in comparison with actual patients by means of radiographic measurements. The volume of the pharyngeal airspace was the primary outcome parameter.
  
  
  METHODS
  Computed tomography scans of 20 adult trauma patients without head or neck injuries were compared with computed tomography scans of four high-fidelity patient simulators and two airway trainers. By using 14 predefined distances, two cross-sectional areas and three volume parameters of the upper airway, the manikins' similarity to a human patient was assessed.
  
  
  RESULTS
  The pharyngeal airspace of all manikins differed significantly from the patients' pharyngeal airspace. The HPS Human Patient Simulator (METI®, Sarasota, FL) was the most realistic high-fidelity patient simulator (6/19 [32%] of all parameters were within the 95% CI of human airway measurements).
  
  
  CONCLUSIONS
  The airway anatomy of four high-fidelity patient simulators and two airway trainers does not reflect the upper airway anatomy of actual patients. This finding may impact airway training and confound comparative airway device studies.
authors.affiliation: Medical Simulation and Emergency Management Research Group, Department of Anesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria. karl.schebesta@meduniwien.ac.at
authors.forename: Karl
authors.initials: K
authors.lastname: Schebesta
authors.forename: Michael
authors.initials: M
authors.lastname: Hüpfl
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rössler
authors.forename: Helmut
authors.initials: H
authors.lastname: Ringl
authors.forename: Michael P
authors.initials: MP
authors.lastname: Müller
authors.forename: Oliver
authors.initials: O
authors.lastname: Kimberger
mesh_terms: D000293:Adolescent; D000328:Adult; D058109:Airway Management; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D003198:Computer Simulation; D004825:Epiglottis / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008348:Manikins; D008875:Middle Aged; D010159:Palate / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D010614:Pharynx / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D012137:Respiratory System / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014059:Tongue / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D055815:Young Adult