Airway registry and training curriculum improve intubation outcomes in the intensive care unit

Abstract

Background: Intubation in critically ill patients remains a highly morbid procedure, and the optimal approach is unclear. We sought to improve the safety of intubation by implementing a simulation curriculum and monitoring performance with an airway registry. Methods and Methods: This is a prospective, single-center observational study of all intubations performed by the medical intensive care unit (ICU) team over a five-year period. All fellows take part in a simulation curriculum to improve airway management performance and minimize complications. An airway registry form is completed immediately after each intubation to capture relevant patient, operator, and procedural data. Results: Over a five-year period, the medical ICU team performed 1411 intubations. From Year 1 to Year 5, there were significant increases in first-attempt success (72.6 vs. 88.0%, p<0.001), use of video laryngoscopy (72.3 vs. 93.5%, p<0.001), and use of neuromuscular blocking agents (73.5 vs. 88.4%, p<0.001). There were concurrent decreases in rates of desaturation (25.6 vs. 17.1%, p=0.01) and esophageal intubations (5 vs. 1%, p=0.009). Low rates of hypotension (8.3%) and cardiac arrest (0.6%) were also observed. Conclusions: The safety of intubation in critically ill patients can be markedly improved through joint implementation of an airway registry and simulation curriculum.

A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit

“…At the same time, increasing the use of high flow nasal cannula and non-invasive positive pressure ventilation, non-PCCM providers managing the airway in the ICU, and increasing number of trainees competing for EIs may be resulting in fewer EI experience for individual trainees. Thankfully, recent PCCM studies have shown that improvements in EI education do translate to improved first pass success, decreased incidence of hypoxia, and decreased incidence of tube misplacement [23][24][25]. That is, several interventions to improve the quality (rather than quantity) of intubation experiences have shown promise for accelerating attainment of trainee competence and improving patient outcomes.…”