Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
Department of Respiratory Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Respir Care. 2020 Oct;65(10):1534-1540. doi: 10.4187/respcare.07667. Epub 2020 Jun 23.
Tracheal intubation by respiratory therapists (RTs) is a well-established practice that has been described primarily in adult and neonatal patients. However, minimal data exist regarding RTs' intubation performance in pediatric ICUs. The purpose of this study was to describe the current landscape of intubations performed by RTs in pediatric ICUs.
A multicenter quality improvement database, the National Emergency Airway Registry for Children (NEAR4KIDS) was queried from 2015 to 2018. We performed a retrospective analysis of prospectively collected data on subject demographics, indication for intubation, difficult airway history and feature presence, provider discipline, medications, and device. Intubation outcomes included first-attempt and overall success rates, adverse events, and oxygen desaturation (ie, [Formula: see text] < 80%). Overall intubation success was defined as intubation achieved in ≤ 2 attempts.
There were 12,056 initial intubation encounters from 46 ICUs, with 109 (0.9%) first attempts performed by RTs. Nine (20%) ICUs reported at least one intubation encounter by RTs. The number of intubations performed by RTs at individual centers ranged from 1 to 46 (RT participation rate: 0.3% to 19.6%). RTs utilized video laryngoscopy more often than other providers (53.2% for RTs vs 28.1% for others, < .001). RTs' first attempt success (RT 60.6% vs other 69.2%, = .051), overall success (RT 76.2 % vs other 82.4%, = .09), and oxygen desaturation [Formula: see text] < 80% (RT 16.5% vs other 16.9%, = .91) were similar to other providers. Adverse events were more commonly reported in intubations by RTs versus by other providers (22.9% vs 13.8%, = .006).
RTs infrequently intubate in pediatric ICUs, with success rates similar to other providers but higher adverse event rates. RTs were more likely to use video laryngoscopy than other providers. RTs' intubation participation, success, and adverse event rates varied greatly across pediatric ICUs.
呼吸治疗师（RT）进行气管插管是一种成熟的做法，主要在成人和新生儿患者中进行描述。然而，关于儿科 ICU 中 RT 插管表现的数据很少。本研究的目的是描述儿科 ICU 中 RT 进行插管的现状。
从 2015 年到 2018 年，使用多中心质量改进数据库——国家儿童急诊气道登记处（NEAR4KIDS）进行查询。我们对前瞻性收集的患者人口统计学、插管适应证、困难气道史和特征存在、提供者学科、药物和设备数据进行回顾性分析。插管结果包括首次尝试和总体成功率、不良事件和氧饱和度下降（即[Formula: see text] < 80%）。总体插管成功率定义为 ≤ 2 次尝试插管成功。
来自 46 个 ICU 的 12056 例初始插管，其中 109 例（0.9%）首次尝试由 RT 完成。9 个（20%）ICU 报告至少有 1 例由 RT 进行的插管。个别中心的 RT 插管次数从 1 次到 46 次不等（RT 参与率：0.3%至 19.6%）。与其他提供者相比，RT 更常使用视频喉镜（RT 53.2%，其他 28.1%，<0.001）。RT 的首次尝试成功率（RT 60.6%与其他 69.2%，=0.051）、总体成功率（RT 76.2%与其他 82.4%，=0.09）和氧饱和度下降[Formula: see text] < 80%（RT 16.5%与其他 16.9%，=0.91）与其他提供者相似。RT 进行的插管比其他提供者更常报告不良事件（22.9%与 13.8%，=0.006）。
RT 很少在儿科 ICU 进行插管，成功率与其他提供者相似，但不良事件发生率更高。RT 更有可能使用视频喉镜，而不是其他提供者。RT 的插管参与、成功率和不良事件发生率在儿科 ICU 之间差异很大。
