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Abstract
BACKGROUND: Tracheal intubation by respiratory therapists (RTs) is a well-established practice that has been described primarily in adult and neonatal patients. However, minimal data exist regarding RTs’ intubation performance in pediatric ICUs. The purpose of this study was to describe the current landscape of intubations performed by RTs in pediatric ICUs.
METHODS: A multicenter quality improvement database, the National Emergency Airway Registry for Children (NEAR4KIDS) was queried from 2015 to 2018. We performed a retrospective analysis of prospectively collected data on subject demographics, indication for intubation, difficult airway history and feature presence, provider discipline, medications, and device. Intubation outcomes included first-attempt and overall success rates, adverse events, and oxygen desaturation (ie, 
< 80%). Overall intubation success was defined as intubation achieved in ≤ 2 attempts.
RESULTS: There were 12,056 initial intubation encounters from 46 ICUs, with 109 (0.9%) first attempts performed by RTs. Nine (20%) ICUs reported at least one intubation encounter by RTs. The number of intubations performed by RTs at individual centers ranged from 1 to 46 (RT participation rate: 0.3% to 19.6%). RTs utilized video laryngoscopy more often than other providers (53.2% for RTs vs 28.1% for others, P < .001). RTs’ first attempt success (RT 60.6% vs other 69.2%, P = .051), overall success (RT 76.2 % vs other 82.4%, P = .09), and oxygen desaturation 
< 80% (RT 16.5% vs other 16.9%, P = .91) were similar to other providers. Adverse events were more commonly reported in intubations by RTs versus by other providers (22.9% vs 13.8%, P = .006).
CONCLUSIONS: RTs infrequently intubate in pediatric ICUs, with success rates similar to other providers but higher adverse event rates. RTs were more likely to use video laryngoscopy than other providers. RTs’ intubation participation, success, and adverse event rates varied greatly across pediatric ICUs.
- endotracheal intubation
- respiratory therapist
- respiratory care practitioner
- RT
- pediatric critical care
- airway management
- intubation
Footnotes
- Correspondence: Andrew G Miller MSc RRT RRT-ACCS RRT-NPS, Duke University Medical Center, 2301 Erwin Rd Durham, NC 27710. E-mail: andrew.g.miller{at}duke.edu
Supplementary material related to this paper is available at http://www.rcjournal.com.
Mr Miller has disclosed a relationship with Ventec Life Systems. Ms Napolitano has disclosed relationships with Draeger, Aerogen, Smiths Medical, Philips/Respironics, Actuated Medical, and VERO-Biotech. Ms Napolitano and Dr Nishisaki are supported by the Agency for Healthcare Research and Quality (AHRQ R03HS021583, R18 HS022464, R18HS024511) and by the Endowed Chair in Critical Care Medicine at Children’s Hospital of Philadelphia. Drs Rehder and Turner have disclosed no conflicts of interest.
- Copyright © 2020 by Daedalus Enterprises
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