Effect of Operator Experience on Outcomes of Emergency Airway Management: The ICU Intubation Learning Curve

Brown, W. G.; Janz, David R.; Russell, Derek W.; Joffe, E.M.; James, David; Vonderhaar, Derek J; West, Jason R.; Rice, Todd W.; Semler, Matthew W.; Casey, Jonathan D

doi:10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a5985

Cited by 3 publications

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“…However, compared to those performed in the OR, EIs performed in the ICU are associated with challenging glottic visualization, higher incidence of "difficult" airways, increased the need for adjunct devices, lower first-pass success, higher incidence of complications, and higher failure rates [6]. Not surprisingly, trainee learning curves vary across environments, with competence in elective OR intubation reported after as few as 43 experiences, but far greater for non-elective procedures [10][11][12][13][14]16]. While OR EI experiences contribute to attainment of competence in this procedure, they may not offer sufficient situational, physiologic, or anatomic complexity to obviate the need for ICU EI experiences.…”

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confidence: 99%

“…One small study concluded that at least 75 procedures are required for emergency medicine trainees to achieve competence in emergent EI [ 12 ]. A recent analysis of close to 1000 ICU intubations performed predominantly by PCCM providers revealed a significant increase in the lowest oxygen saturation experienced by critically ill adults undergoing tracheal intubation between 100 and 200 previous operator EIs [ 13 ]. Still others advocate for 200 intubations to achieve independent practice in EI in the ICU [ 14 ].…”

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confidence: 99%

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

et al. 2020

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Endotracheal intubation (EI) is a potentially lifesaving but high-risk procedure in critically ill patients. While the ACGME mandates that trainees in pulmonary and critical care medicine (PCCM) achieve competence in this procedure, there is wide variation in EI training across the USA. One study suggests that 40% of the US PCCM trainees feel they would not be proficient in EI upon graduation. This article presents a review of the EI training literature; the recommendations of a national group of PCCM, anesthesiology, emergency medicine, and pediatric experts; and a call for further research, collaboration, and consensus guidelines.

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confidence: 99%

Section: Main Textmentioning

confidence: 99%

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

et al. 2020

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“…Depending who performed the first attempt, the next attempt should be performed by a more experienced operator, likely the most experienced in the room. 49 If anesthesia has not already responded to the trauma activation, they should be summoned to the room to increase the number of team members with advanced airway experience and expertise. Prior to the next attempt, the patient should once again receive preoxygenation as this will allow safe apnea time for the next attempt, which will presumably be more difficult and may take longer.…”

Section: Failed Orotracheal Intubationmentioning

confidence: 99%

Western Trauma Association critical decisions in trauma: airway management in adult trauma patients

Brown¹,

Inaba

Shatz

et al. 2020

Trauma Surg Acute Care Open

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Impact of number of critical care procedural skill repetitions on supervision level and teaching style

Zante

2023

PLoS ONE

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Background During critical care procedural skills training (e.g., in intubation and pericardiocentesis) the appropriate supervision level is important to ensure correct use of techniques and guarantee patient safety. The appropriate teaching style should be selected to address residents’ learning behavior and foster their competence. The aim of this study was to explore the number of repetitions for given skills needed to achieve a specified supervision level and a specific teaching style. Methods This cross-sectional multicenter survey obtained data from residents and faculty of three multidisciplinary intensive care units (ICU) in Switzerland. Using a 4-point Likert scale, participants were asked to indicate the number of repetitions required to achieve the specified supervision level and teaching style. Results Among 91 physicians, the response rate was 64% (n = 59). Their median estimations of the numbers of skill repetitions needed to achieve the final fourth level of supervision and final fourth stage of teaching style were as follows: arterial catheter insertion: supervision level 32, teaching style 17.5; peritoneal paracentesis: supervision level 27, teaching style 17; central venous catheter insertion: supervision level 38, teaching style 28; lumbar puncture: supervision level 38, teaching style 21; endotracheal intubation: supervision level 100, teaching style 45; chest drain insertion: supervision level 27, teaching style 21.5; temporary pacemaker placement: supervision level 50, teaching style 19.5; percutaneous tracheostomy: supervision level 50, teaching style 29; pericardiocentesis: supervision level 50, teaching style 35. Comparison of repetitions between supervision level and teaching style revealed no difference at the first and second levels, except for endotracheal intubation at level 2 (p = 0.03). Differences were observed at the third and fourth levels of supervision level and teaching style (p≤0.04). Conclusions It appears that the supervision level and teaching style applied by faculty should change according to both the number of repetitions and the difficulty of critical care procedural skills.

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Effect of Operator Experience on Outcomes of Emergency Airway Management: The ICU Intubation Learning Curve

Cited by 3 publications

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

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

Western Trauma Association critical decisions in trauma: airway management in adult trauma patients

Impact of number of critical care procedural skill repetitions on supervision level and teaching style

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