Attending Intubation Success Rate Is Lower in the Pediatric ICU With PCCM Fellowship Program

First Author(s)

• MK

  Mizue Kishida

  n/a

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• RB

  Robert Berg, MD, MCCM (he/him/his)

  Division Chief, Pediatric Critical Care Medicine
  Children's Hospital of Philadelphia
  Merion Station, Pennsylvania, United States

  Disclosure information not submitted.
• 

  Natalie Napolitano, MPH, MPH, RRT-NPS (she/her/hers)

  Research Clinical Specialist
  The Children's Hospital of Philadelphia
  Philadelphia, Pennsylvania, United States

  Disclosure information not submitted.
• JS

  Justine Shults, PhD

  Professor of Biostatistics
  Perelman School of Medicine, United States

  Disclosure information not submitted.
• 

  Vinay Nadkarni, MD, MS, FCCM (he/him/his)

  Professor, Anesthesiology, Critical Care and Pediatrics
  University of Pennsylvania Perelman School of Medicine, CHOP
  Media, Pennsylvania, United States

  Disclosure information not submitted.
• AN

  Akira Nishisaki, MD, MSCE

  Associate Professor of Anesthesia and Critical Care Medicine
  The Children's Hospital of Philadelphia, United States

  Disclosure information not submitted.

Title: Attending intubation success rate is lower in the Pediatric ICU with PCCM fellowship program

BACKGROUND/HYPOTHESIS:Tracheal intubation (TI) is a critical skill to maintain as a pediatric intensivist. Attending physicians (AP) may have limited procedural opportunities as the laryngoscopist in pediatric ICUs with fellowship programs (FP). We hypothesize AP would have fewer first TI provider attempts and less first TI attempt success rate in ICUs with FP vs. ICU without FP; and this association would be attenuated in ICUs where AP TI skill refresher programs exist.

Method: Analysis of the NEAR4KIDS database from 7/2016-6/2020, with site survey for presence of FP and AP TI refresher. Multivariable regression with Generalized Estimating Equations (GEE) for AP first attempt success, accounting for site clustering and covariates.

Results: 33 pediatric ICUs with 11,323 TIs, 23/33 (70%) ICUs had FP, and 3/23 (13%) with FP had AP TI refresher. AP participation as the 1st airway provider was 8.7% in ICUs with FP vs. 57.1% without FP, p< 0.001. Among TIs with AP as laryngoscopist (n=2,052), AP first attempt success rate was 72.9% in ICUs with FP vs. 83.1% without FP, p< 0.001. In both types of ICUs, AP first attempt success rates were higher compared to all other TIs (P< 0.001). After controlling for age, diagnosis, indication, difficult airway history and feature, device, apneic oxygenation, use of paralytic, and site level clustering, AP in ICUs with FP had significantly lower odds for first attempt success (aOR: 0.65, 95% CI 0.47-0.90, p=0.01). 3 ICUs with FP have AP TI refresher: 2 ICUs with required number of TI per year and operating room rotation, and 1 ICU with simulation. Among ICUs with FP, the AP first attempt success was similar in ICUs with AP refresher vs. without (75.5% vs. 72.1%, p=0.40). After adjusting for confounders, AP in both ICUs with FP with/without AP refresher had lower first attempt success rate when compared to AP in ICUs without FP: AP with refresher aOR 0.62 (95% CI 0.42-0.91), AP without refresher aOR 0.66 (95% CI 0.51-0.86).

Conclusion: Attending Physicians in ICUs with FP have limited TI opportunities as the first airway provider and is associated with lower first attempt success rate compared to AP in ICUs without FP. This difference was not attenuated by the presence of the AP TI refresher programs.