Respiratory Therapist Intubation Practice in Pediatric ICUs: A Multicenter Registry Study

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Therapy
• Airway Management

Background:

• Tracheal intubation by respiratory therapists (RTs) is established in adult and neonatal care.
• Limited data exist on RTs' intubation performance in pediatric intensive care units (PICUs).

Purpose of the Study:

• To describe the current landscape of tracheal intubations performed by RTs in pediatric ICUs.
• To analyze RTs' intubation success rates and adverse events compared to other providers.

Main Methods:

• Retrospective analysis of prospectively collected data from the National Emergency Airway Registry for Children (NEAR4KIDS) database (2015-2018).
• Inclusion of 12,056 intubation encounters from 46 pediatric ICUs.
• Comparison of intubation outcomes (success rates, adverse events, oxygen desaturation) between RTs and other providers.

Main Results:

• RTs performed 0.9% of first attempts (109 encounters) across 20% of participating ICUs.
• RTs utilized video laryngoscopy more frequently (53.2% vs. 28.1%, P < .001).
• RTs had similar first-attempt (60.6% vs. 69.2%, P = .051) and overall success rates (76.2% vs. 82.4%, P = .09) but higher adverse event rates (22.9% vs. 13.8%, P = .006).

Conclusions:

• RTs infrequently intubate in pediatric ICUs, with varying participation and outcomes across centers.
• RTs demonstrate comparable intubation success rates to other providers but a higher incidence of adverse events.
• Increased use of video laryngoscopy by RTs warrants further investigation into its impact on outcomes.