Research Activities, September 2013
More intensive pediatric resident training called for to improve performance of tracheal intubations in children
Patient Safety and Quality
Tracheal intubation is one of the most important ways to stabilize critically ill or injured children to ensure they get enough oxygen and eliminate carbon dioxide. The ability to manage the pediatric airway, which includes performing needed tracheal intubations, remains one of the most vital skills to develop when caring for critically ill children. Little is known about the relationship between provider level of training in pediatric intensive care units (PICUs) and either successful tracheal intubations or adverse tracheal intubation-associated events (TIAEs). However, a new study suggests that before permitting live tracheal intubations in the PICU, more intensive pediatric resident training is necessary.
In a study of 1,265 tracheal intubations performed in 15 different PICUs, first and overall attempt success rates varied between pediatric residents (37 percent, 51 percent), pediatric critical care fellows (70 percent, 89 percent), and PICU attending physicians (72 percent, 94 percent). Among the 1,265 tracheal intubations, there were 270 adverse TIAEs. The most frequently reported nonsevere TIAE was the immediate recognition of esophageal intubation (125 events), while the most frequently reported severe TIAE was hypotension (observed in 46 encounters).
Pediatric critical care fellows were associated with significantly fewer TIAEs than pediatric residents. Across a broad spectrum of PICU settings, the success rate of medical residents was low and adverse associated events high compared with rates for pediatric fellows or attending physicians. While some of the TIAEs were not considered severe, they can potentially harm children who are already critically ill.
More training for residents and assessment of the skill set of trainee providers to match patient's potential risks are necessary to avoid complications, suggest the researchers. Their study was funded by AHRQ (HS21582).
See "Level of trainee and tracheal intubation outcomes," by Ronald C. Sanders, Jr., M.D., John S. Giuliano, Jr., M.D., Janice E. Sullivan, M.D., and others in Pediatrics 131, p. e821-e828, 2013.