TY - JOUR
T1 - Tracheal Intubation by Attending Physicians in a U.S. Registry, 2016–2020
T2 - Analysis by PICU Participation in a Skills Maintenance Program and Fellowship Training
AU - Kishida, Mizue
AU - Berg, Robert A.
AU - Napolitano, Natalie
AU - Berkenbosch, John
AU - Talukdar, Andrea
AU - Jung, Philipp
AU - Malone, Matthew P.
AU - Parsons, Simon J.
AU - Harwayne-Gidansky, Ilana
AU - Nett, Sholeen
AU - Glater, Lily
AU - Krawiec, Conrad
AU - Shenoi, Asha
AU - Al-Subu, Awni
AU - Polikoff, Lee
AU - Kelly, Serena P.
AU - Adams, Carolyn K.
AU - GiulianoJr, John S.
AU - Ambati, Shashikanth
AU - Tellez, David
AU - Martin, Rebecca J.
AU - Lee, Anthony
AU - Breuer, Ryan K.
AU - Biagas, Katherine V.
AU - Mallory, Palen P.
AU - Corbett, Kelly L.
AU - Bysani, G. Kris
AU - Ducharme-Crevier, Laurence
AU - Wirkowski, Samantha
AU - Pinto, Matthew
AU - Toal, Megan
AU - Marlow, Rachel K.
AU - Adu-Darko, Michelle
AU - Shults, Justine
AU - Nadkarni, Vinay
AU - Nishisaki, Akira
N1 - Publisher Copyright:
Copyright © 2025 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2025/2/1
Y1 - 2025/2/1
N2 - OBJECTIVES: Tracheal intubation (TI) is a critical skill for PICU attending physicians to maintain. We hypothesize that attendings perform fewer TIs and have lower success rate in PICU programs with a Pediatric Critical Care Medicine (PCCM) fellowship. DESIGN: Retrospective study using the National Emergency Airway Registry for Children (NEAR4KIDS) from July 2016 to June 2020. Exposures were presence of PCCM fellowship and attending TI skill maintenance program (SMP). The primary outcome was attending’s first attempt success and the secondary outcome was adverse airway outcome in the first attempt. SETTING: Thirty-three PICUs in North America. PATIENTS: Children receiving TI. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall, 23 of 33 PICUs had a PCCM fellowship with three of 23 having an attending TI SMP. Attendings performed TI in 24.1% (2,728/11,323): 13.9% (13.8 TI/yr per PICU) in PICUs with a fellowship vs. 66.0% (36.6 TI/yr per PICU) without a fellowship (p < 0.001). Attending first attempt success in PICUs with vs. without fellowships was 70.5% vs. 81.3% (difference, 10.8% [95% CI, 7.6–14.0%]; p < 0.0001). After controlling for confounders, attendings in a PICU with a fellowship had lower odds for first attempt success (adjusted odds ratio [aOR], 0.65 [95% CI, 0.47–0.90]). We failed to find an association between attending first attempt success and PICU program type, with vs. without a TI SMP (74.0% vs. 69.5%; p = 0.146). The adverse airway outcome rate of the TI with attending’s first attempt was lower in PICU programs with vs. without a TI SMP (32.8% vs. 40.3%; p = 0.020). However, after adjusting for confounders, we failed to exclude the possibility of near halving of odds of adverse outcome (aOR, 0.75 [95% CI, 0.55–1.01]; p = 0.058). CONCLUSIONS: Attendings in PICU programs with a fellowship have fewer opportunities to perform TI and lower first attempt success rates. Opportunities exist for attending TI skill maintenance, especially in PICUs with a PCCM fellowship.
AB - OBJECTIVES: Tracheal intubation (TI) is a critical skill for PICU attending physicians to maintain. We hypothesize that attendings perform fewer TIs and have lower success rate in PICU programs with a Pediatric Critical Care Medicine (PCCM) fellowship. DESIGN: Retrospective study using the National Emergency Airway Registry for Children (NEAR4KIDS) from July 2016 to June 2020. Exposures were presence of PCCM fellowship and attending TI skill maintenance program (SMP). The primary outcome was attending’s first attempt success and the secondary outcome was adverse airway outcome in the first attempt. SETTING: Thirty-three PICUs in North America. PATIENTS: Children receiving TI. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall, 23 of 33 PICUs had a PCCM fellowship with three of 23 having an attending TI SMP. Attendings performed TI in 24.1% (2,728/11,323): 13.9% (13.8 TI/yr per PICU) in PICUs with a fellowship vs. 66.0% (36.6 TI/yr per PICU) without a fellowship (p < 0.001). Attending first attempt success in PICUs with vs. without fellowships was 70.5% vs. 81.3% (difference, 10.8% [95% CI, 7.6–14.0%]; p < 0.0001). After controlling for confounders, attendings in a PICU with a fellowship had lower odds for first attempt success (adjusted odds ratio [aOR], 0.65 [95% CI, 0.47–0.90]). We failed to find an association between attending first attempt success and PICU program type, with vs. without a TI SMP (74.0% vs. 69.5%; p = 0.146). The adverse airway outcome rate of the TI with attending’s first attempt was lower in PICU programs with vs. without a TI SMP (32.8% vs. 40.3%; p = 0.020). However, after adjusting for confounders, we failed to exclude the possibility of near halving of odds of adverse outcome (aOR, 0.75 [95% CI, 0.55–1.01]; p = 0.058). CONCLUSIONS: Attendings in PICU programs with a fellowship have fewer opportunities to perform TI and lower first attempt success rates. Opportunities exist for attending TI skill maintenance, especially in PICUs with a PCCM fellowship.
UR - https://www.scopus.com/pages/publications/85219052474
UR - https://www.scopus.com/pages/publications/85219052474#tab=citedBy
U2 - 10.1097/PCC.0000000000003646
DO - 10.1097/PCC.0000000000003646
M3 - Article
C2 - 39982154
AN - SCOPUS:85219052474
SN - 1529-7535
VL - 26
SP - e166-e176
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 2
ER -