Level of trainee and tracheal intubation outcomes.

نویسندگان

  • Ronald C Sanders
  • John S Giuliano
  • Janice E Sullivan
  • Calvin A Brown
  • Ron M Walls
  • Vinay Nadkarni
  • Akira Nishisaki
چکیده

BACKGROUND Tracheal intubation is an important intervention to stabilize critically ill and injured children. Provider training level has been associated with procedural safety and outcomes in the neonatal intensive care settings. We hypothesized that tracheal intubation success and adverse tracheal intubation-associated events are correlated with provider training level in the PICU. METHODS A prospective multicenter observational cohort study was performed across 15 PICUs to evaluate tracheal intubation between July 2010 to December 2011. All data were collected by using a standard National Emergency Airway Registry for Children reporting system endorsed as a Quality Improvement project of the Pediatric Acute Lung Injury and Sepsis Investigator network. Outcome measures included first attempt success, overall success, and adverse tracheal intubation-associated events. RESULTS Reported were 1265 primary oral intubation encounters by pediatric providers. First and overall attempt success were residents (37%, 51%), fellows (70%, 89%), and attending physicians (72%, 94%). After adjustment for relevant patient factors, fellow provider was associated with a higher rate of first attempt success (odds ratio [OR], 4.29; 95% confidence interval [CI], 3.24-5.68) and overall success (OR, 9.27; 95% CI, 6.56-13.1) compared with residents. Fellow (versus resident) as first airway provider was associated with fewer tracheal intubation associated events (OR, 0.42; 95% CI, 0.31-0.57). CONCLUSIONS Across a broad spectrum of PICUs, resident provider tracheal intubation success is low and adverse associated events are high, compared with fellows. More intensive pediatric resident procedural training is necessary before "live" tracheal intubations in the intensive care setting.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Effects of remifentanil and alfentanil on cardiovascular responses to tracheal intubation

Introduction: Laryngoscopy and tracheal intubation necessitate to start a surgery and induction of general anesthesia as well as the maintenance of the air way and to provide ventilation. However, Laryngoscopy and tracheal intubation may lead to hemodynamic response that appear with the symptoms of hypertension tachycardia, arrhythmia and myocardial ischemia and results in myocardial infarction...

متن کامل

Surgical treatment for patients with tracheal and subgllotic stenosis

  Abstract   Background: Iatrogenic airway injury after endotracheal intubation and tracheotomy   remains a serious clinical problem. In this study we reviewed post-intubation and traumatic tracheal stenosis in 47 patients with a special attention to the cause, hense surgical treatment of the stenosis was performed and the results compared with the literatures.   Methods: Since February 1995 th...

متن کامل

Learning Curves of Macintosh Laryngoscope in Nurse Anesthetist Trainees Using Cumulative Sum Method

Background. Tracheal intubation is a potentially life-saving procedure. This skill is taught to many anesthetic healthcare professionals, including nurse anesthetists. Our goal was to evaluate the learning ability of nurse anesthetist trainees in their performance of orotracheal intubation with the Macintosh laryngoscope. Methods. Eleven nurse anesthetist trainees were enrolled in the study dur...

متن کامل

گزارش یک مورد پارگی تراشه بعد از اینتوباسیون ودرمان آن با روش تراکئوستومی با دیلاتاسیون زیر جلدی

Post-intubation tracheal rupture is a rare and potentially fatal complication. Usually fraction of post-intubation tracheal injuries are undiagnosed, misdiagnosed, or underreported, therefore, the actual incidence and outcomes of such injuries are unknown. The incidence of reported cases is approximately 1 in every 20,000 intubation attempts. The most common causes are cuff over inflation and r...

متن کامل

صدمات ناشی از لوله گذاری طولانی مدت بر نای و حنجره

Background: Prolonged endotracheal intubation is a growing method for supporting ventilation in patients who require intensive care. Despite considerable advancement in endotracheal intubation, this method still has some complications the most important is laryngo-tracheal injuries.                    Methods: Over a 2-year period, this retrospective study was conducted on 57 patients with hist...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Pediatrics

دوره 131 3  شماره 

صفحات  -

تاریخ انتشار 2013