Variation in Intensive Care Unit Intubation Practices in Pulmonary Critical Care Medicine Fellowship.

• Type of Material: Article
• Authors: Anna K. Brady, Oregon Health & Science University; Wade Brown, Vanderbilt University; Joshua L. Denson, Tulane University; Gretchen Winter, University of Alabama Birmingham; Abesh Niroula, Emory University; Lekshmi Santhosh, University of California San Francisco; W. Graham Carlos, Indiana University
• Language: English
• Date: 2020-12
• Publisher: American Thoracic Society
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the American Thoracic Society
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.34197/ats-scholar.2020-0004OC
• Title of Journal or Parent Work: ATS Sch
• Volume: 1
• Issue: 4
• Start Page: 395
• End Page: 405
• Grant/Funding Information: W.B. was supported by the Agency for Healthcare Research and Quality grant T32 HS026122-01.
• Keywords: intratracheal; Intubation; medical; education
• Research Categories: Health Sciences, Medicine and Surgery; Education, Health; Health Sciences, Health Care Management

Abstract

Background: Endotracheal intubation in the intensive care unit (ICU) is a high-risk procedure. Competence in endotracheal intubation is a requirement for Pulmonary and Critical Care Medicine (PCCM) training programs, but fellow experience as the primary operator in intubating ICU patients has not been described on a large scale. Objective: We hypothesized that significant variation surrounding endotracheal intubation practices in medical ICUs exists in United States (US) PCCM training programs. Methods: We administered a survey to a convenience sample of US PCCM fellows to elicit typical intubation practices in the medical ICU. Results: 89 discrete US PCCM and Internal Medicine CCM training programs (77% response rate) were represented. At 43% of programs, the PCCM fellow was "always or almost always" designated the primary operator for intubation of a medical ICU patient, whereas at 21% of programs, the PCCM fellow was "rarely or never" the primary operator responsible for intubating in the ICU. Factors influencing this variation included time of day, hospital policies, attending skill or preference, ICU census and acuity, and patient factors. There was an association between location of the training program, but not program size, and whether the PCCM fellow was the primary operator. Conclusion: There is significant variation in whether PCCM fellows are the primary operators to intubate medical ICU patients during training. Further work should explore how this variation affects fellow career development and competence in intubation.