Respiratory Therapist Intubation Practice in Pediatric ICUs: A Multicenter Registry Study
Related Experiment Video
Updated: Dec 17, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Andrew G Miller1, Natalie Napolitano2, David A Turner3
1Respiratory Care Services, Duke University Medical Center, Durham, North Carolina. andrew.g.miller@duke.edu.
Insights
Respiratory therapists (RTs) infrequently perform tracheal intubations in pediatric intensive care units (ICUs). While RTs show similar success rates to other providers, they experience higher adverse event rates and utilize video laryngoscopy more frequently.
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.
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, [Formula: see text] < 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 = .09), and oxygen desaturation [Formula: see text] < 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.
Related Concept Videos
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....