Variation in Intensive Care Unit Intubation Practices in Pulmonary Critical Care Medicine Fellowship

Area of Science:

• Medical Education
• Intensive Care Medicine
• Respiratory Therapy

Background:

• Endotracheal intubation in the intensive care unit (ICU) is a high-risk procedure.
• Fellow competence in endotracheal intubation is a requirement for Pulmonary and Critical Care Medicine (PCCM) training.
• Large-scale data on fellow experience as the primary operator for ICU intubations is lacking.

Purpose of the Study:

• To test the hypothesis that significant variation exists in endotracheal intubation practices within US PCCM training programs.
• To describe the role of PCCM fellows as primary operators for medical ICU intubations.

Main Methods:

• A survey was administered to a convenience sample of US PCCM fellows.
• The survey aimed to elicit typical intubation practices in the medical ICU.
• Data were collected from 89 US PCCM and Internal Medicine CCM training programs.

Main Results:

• A substantial variation was observed in PCCM fellows' roles as primary operators for ICU intubations (43% always/almost always vs. 21% rarely/never).
• Factors influencing this variation include time of day, hospital policies, attending preferences, and patient acuity.
• Training program location, but not size, was associated with whether fellows were primary operators.

Conclusions:

• Significant variation exists in PCCM fellows' primary operator experience for medical ICU intubations.
• Further research is needed to understand how this variation affects fellow career development and intubation competence.