RT Journal Article
SR Electronic
T1 Respiratory Therapist Intubation Practice in Pediatric ICUs: A Multicenter Registry Study
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.07667
DO 10.4187/respcare.07667
A1 Andrew G Miller
A1 Natalie Napolitano
A1 David A Turner
A1 Kyle J Rehder
A1 Akira Nishisaki
A1 for the National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)
YR 2020
UL http://rc.rcjournal.com/content/early/2020/06/23/respcare.07667.abstract
AB 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, SpO2 < 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 = .087), and oxygen desaturation SpO2 < 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.