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Pediatr Crit Care Med. 2018 Feb 5. doi: 10.1097/PCC.0000000000001470. [Epub ahead of print]

Downward Trend in Pediatric Resident Laryngoscopy Participation in PICUs.

Author information

1
Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, Philadelphia, PA.
2
Department of Pediatrics, Section of Pediatric Critical Care, UAMS/Arkansas Children's Hospital, Little Rock, AR.
3
Department of Pediatrics, Section of Pediatric Critical Care, Kentucky Children's Hospital, University of Kentucky, Lexington, KY.
4
Pediatric Critical Care, Norton Children's Hospital, University of Louisville, Louisville, KY.
5
Department of Pediatrics, Section of Critical Care Medicine, Alberta Children's Hospital, Calgary, AB, Canada.
6
Department of Pediatrics, Division of Critical Care Medicine, Cohen's Children's Medical Center, New Hyde Park, NY.
7
Pediatric Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
8
Respiratory Care Department, Children's Hospital of Philadelphia, Philadelphia, PA.
9
Pediatric Critical Care Medicine, Department of Pediatrics, Brown University Hasbro Children's Hospital, Providence, RI.
10
Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
11
Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.
12
Department of Pediatrics, CHU Sainte Justine, Université de Montréal, Montreal, QC, Canada.
13
Pediatric Critical Care Department, University of Virginia Hospital, Charlottesville, VA.
14
Pediatric Intensive Care Unit, Section of Pediatric Critical Care, Yale University School of Medicine, New Haven, CT.
15
Division of Critical Care, Miami Children's Hospital, Miami, FL.
16
Pediatric Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.
17
Division of Pediatric Critical Care, Department of Pediatrics, Duke Children's Hospital, Durham, NC.
18
Pediatric Critical Care, Department of Pediatrics, Penn State Children's Hospital, Hershey, PA.
19
Pediatric Critical Care Medicine, Stony Brook Children's Hospital, Stony Brook, NY.
20
Pediatric Critical Care, Oregon Health and Science University, Portland, OR.
21
Division of Critical Care Medicine, Department of Pediatrics, Women's and Children's Hospital of Buffalo, Buffalo, NY.
22
Division of Pediatric Critical Care, Phoenix Children's Hospital, Phoenix, AZ.
23
Respiratory Therapy, Kentucky Children's Hospital, UK HealthCare, Lexington, KY.
24
Department of Pediatrics, Division of Pediatric Critical Care Medicine, Maria Fareri Children's Hospital, Valhalla, NY.
25
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.

Abstract

OBJECTIVES:

As of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency in nonneonatal tracheal intubation. We hypothesized that laryngoscopy by pediatric residents has decreased over time, with a more pronounced decrease after this guideline change.

DESIGN:

Prospective cohort study.

SETTING:

Twenty-five PICUs at various children's hospitals across the United States.

PATIENTS:

Tracheal intubations performed in PICUs from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children).

INTERVENTION:

None.

MEASUREMENTS AND MAIN RESULTS:

Prospective cohort study in which all primary tracheal intubations occurring in the United States from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children) were analyzed. Participating PICU leaders were also asked to describe their local airway management training for residents. Resident participation trends over time, stratified by presence of a Pediatric Critical Care Medicine fellowship and airway training curriculum for residents, were described. A total of 9,203 tracheal intubations from 25 PICUs were reported. Pediatric residents participated in 16% of tracheal intubations as first laryngoscopists: 14% in PICUs with a Pediatric Critical Care Medicine fellowship and 34% in PICUs without one (p < 0.001). Resident participation decreased significantly over time (3.4% per year; p < 0.001). The decrease was significant in ICUs with a Pediatric Critical Care Medicine fellowship (p < 0.001) but not in ICUs without one (p = 0.73). After adjusting for site-level clustering, patient characteristics, and Pediatric Critical Care Medicine fellowship presence, the Accreditation Council for Graduate Medical Education guideline change was not associated with lower participation by residents (odds ratio, 0.86; 95% CI, 0.59-1.24; p = 0.43). The downward trend of resident participation was similar regardless of the presence of an airway curriculum for residents.

CONCLUSION:

Laryngoscopy by pediatric residents has substantially decreased over time. This downward trend was not associated with the 2013 Accreditation Council for Graduate Medical Education change in residency requirements.

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