A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit
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A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit Wade Brown1* , Lekshmi Santhosh2, Anna K. Brady3, Joshua L. Denson4, Abesh Niroula5, Meredith E. Pugh1, Wesley H. Self6, Aaron M. Joffe7, P. O’Neal Maynord8 and W. Graham Carlos9 Abstract 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. Keywords: Intubation, intratracheal, Education, Emergency medicine, Critical care, Anesthesiology, Teaching, Critical illness, Laryngoscopy, Manikins, Learning curve, Education, medical, graduate, Consensus, Guideline
Main text Endotracheal intubation (EI) is a potentially lifesaving but high-risk procedure in critically ill patients [1]. Complications occur in more than half of all adult intensive care unit (ICU) endotracheal intubations with severe hypoxemia in 26% and hemodynamic collapse in 25% [2]. At the extreme, cardiac arrest occurs in up to 3% and death in up to 1% of patients [2, 3]. These rates reflect the anatomic, physiologic, and situational complexity of EI in the critically ill patient [4–6]. While the ACGME mandates that trainees in pulmonary and critical care medicine (PCCM) be competent in this procedure, there is wide variation in the number of EI procedures, the type of EI experiences, and the nature of organized training for this procedure in PCCM programs across the USA [7, 8]. In one survey of PCCM program directors (PDs), 14% of programs * Correspondence: [email protected] 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1218 Medical Center North, 1211 Medical Center Drive, Nashville, TN 37232, USA Full list of author information is available at the end of the article
reported providing no bedside ICU intubation experiences and 5% reported no formal EI training methodology at all [8]. A separate national survey of PCCM PDs and fellows documented that as many as 67% of programs had no protocol for teaching EI and also noted significant discrepancy between PD and fellow perceptions of training for EI [9]. Forty percent of PCCM trainees felt they would not be proficient in EI upon completion of training [9]. On average, PCCM PDs felt that trainees required 33 EI experiences to become proficient in this procedure [9]. A similar study found that 2/3rds of PCCM PDs felt that < 39 direct laryngoscopy experiences were sufficient to obtain competence [8]. In that same study, 67% of PDs reported
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