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Acquiring procedural skills in ICUs: a prospective multicenter study*.

Damien Roux1, Jean Reignier, Guillaume Thiery

  • 11AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France. 2UMRS-722, Univ Paris Diderot, Sorbonne Paris Cité, UMRS-722, Paris, France. 3Service de Réanimation Polyvalente, CHD Les Oudaries, La Roche sur Yon, France. 4AP-HP, Hôpital Saint-Louis, Service de Réanimation Médicale, Paris, France. 5Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, CHU Bordeaux, Bordeaux, France. 6Service de Réanimation Polyvalente, CHI Poissy-Saint-Germain en Laye, site de Saint-Germain, Saint-Germain en Laye, France. 7Service de Réanimation, CHU, Clermont Ferrand, France. 8Service de Réanimation Médicale, Hôpital Sainte Marguerite, Marseille, France. 9Service de Réanimation Médicale, CHU Angers, Angers, France. 10Service de Réanimation Médicale, CHU Nice, Nice, France. 11AP-HP, Hôpital Pitié-Salpétrière, Service de Réanimation Médicale, Paris, France. 12AP-HP, Hôpital Cochin, Service de Réanimation Médicale, Paris, France. 13AP-HP, Hôpital Européen Georges Pompidou, Service de Réanimation Médicale, Paris, France. 14Service de Réanimation Médicale, Hôpital de la Côte de Nacre, Caen, France. 15Service de Réanimation Médicale, Hôpital de la Cavale Blanche, Brest, France. 16Service de Réanimation Médicale, CHU Tours, Tours, France. 17Service de Réanimation Médicale, CHU de Strasbourg, Strasbourg, France. 18Service de Réanimation Polyvalente, Hôpital Delafontaine, Saint-Denis, France. 19AP-HP, Hôpital Bichat, Service de Réanimation Médicale, Paris, France. 20Service de Réanimation Médicale et Polyvalente Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France.

Critical Care Medicine
|November 27, 2013
PubMed
Summary

Procedural skills acquisition in French intensive care units (ICUs) is safe for residents, with complication rates similar to existing literature. Identifying specific risk factors for procedures like intubation can guide targeted training for improved patient safety.

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Area of Science:

  • Critical Care Medicine
  • Medical Education
  • Patient Safety

Background:

  • Training residents in procedural skills within intensive care units (ICUs) presents a significant challenge, balancing skill acquisition with patient safety through supervision.
  • Evaluating the effectiveness and safety of procedural skill acquisition in French ICUs is crucial for refining training protocols.

Purpose of the Study:

  • To assess the efficacy and safety of procedural skill acquisition among residents in French ICUs.
  • To identify specific risk factors associated with procedural failures and complications during resident training.

Main Methods:

  • A multicenter prospective observational study was conducted over two consecutive semesters.
  • Data were collected on invasive procedures performed by 84 residents, including tracheal intubations, arterial and central venous catheter insertions, fiberoptic bronchoscopies, and chest tube insertions.
  • Failure and complication rates, along with the level of supervision and assistance, were recorded.

Main Results:

  • A total of 5,617 procedures were analyzed, with complication rates generally low and consistent with published data (e.g., 8.6% desaturation during intubation).
  • Risk factors for increased failure and complications were identified, such as limited prior experience for intubation and left-sided insertion for internal jugular vein catheterization.
  • Supervision varied, being more frequent early in the semester and for certain procedures, while access to fiberoptic bronchoscopy and chest tube insertion was limited for residents.

Conclusions:

  • Procedural skill acquisition in the ICU setting is feasible and safe, with complication rates comparable to existing literature.
  • Specific procedures and situations associated with higher risks were identified, suggesting a need for proactive and targeted training interventions.
  • Further research is needed to establish definitive procedural volume benchmarks for competence and optimize training methodologies.