2016 - 2020年美国登记处主治医生进行的气管插管：根据儿科重症监护病房参与技能维持计划和专科培训进行的分析
Tracheal Intubation by Attending Physicians in a U.S. Registry, 2016-2020: Analysis by PICU Participation in a Skills Maintenance Program and Fellowship Training.
作者信息
Kishida Mizue, Berg Robert A, Napolitano Natalie, Berkenbosch John, Talukdar Andrea, Jung Philipp, Malone Matthew P, Parsons Simon J, Harwayne-Gidansky Ilana, Nett Sholeen, Glater Lily, Krawiec Conrad, Shenoi Asha, Al-Subu Awni, Polikoff Lee, Kelly Serena P, Adams Carolyn K, Giuliano John S, Ambati Shashikanth, Tellez David, Martin Rebecca J, Lee Anthony, Breuer Ryan K, Biagas Katherine V, Mallory Palen P, Corbett Kelly L, Bysani G Kris, Ducharme-Crevier Laurence, Wirkowski Samantha, Pinto Matthew, Toal Megan, Marlow Rachel K, Adu-Darko Michelle, Shults Justine, Nadkarni Vinay, Nishisaki Akira
机构信息
Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
出版信息
Pediatr Crit Care Med. 2025 Feb 1;26(2):e166-e176. doi: 10.1097/PCC.0000000000003646. Epub 2025 Feb 6.
OBJECTIVES
Tracheal intubation (TI) is a critical skill for PICU attending physicians to maintain. We hypothesize that attendings perform fewer TIs and have lower success rate in PICU programs with a Pediatric Critical Care Medicine (PCCM) fellowship.
DESIGN
Retrospective study using the National Emergency Airway Registry for Children (NEAR4KIDS) from July 2016 to June 2020. Exposures were presence of PCCM fellowship and attending TI skill maintenance program (SMP). The primary outcome was attending's first attempt success and the secondary outcome was adverse airway outcome in the first attempt.
SETTING
Thirty-three PICUs in North America.
PATIENTS
Children receiving TI.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Overall, 23 of 33 PICUs had a PCCM fellowship with three of 23 having an attending TI SMP. Attendings performed TI in 24.1% (2,728/11,323): 13.9% (13.8 TI/yr per PICU) in PICUs with a fellowship vs. 66.0% (36.6 TI/yr per PICU) without a fellowship (p < 0.001). Attending first attempt success in PICUs with vs. without fellowships was 70.5% vs. 81.3% (difference, 10.8% [95% CI, 7.6-14.0%]; p < 0.0001). After controlling for confounders, attendings in a PICU with a fellowship had lower odds for first attempt success (adjusted odds ratio [aOR], 0.65 [95% CI, 0.47-0.90]). We failed to find an association between attending first attempt success and PICU program type, with vs. without a TI SMP (74.0% vs. 69.5%; p = 0.146). The adverse airway outcome rate of the TI with attending's first attempt was lower in PICU programs with vs. without a TI SMP (32.8% vs. 40.3%; p = 0.020). However, after adjusting for confounders, we failed to exclude the possibility of near halving of odds of adverse outcome (aOR, 0.75 [95% CI, 0.55-1.01]; p = 0.058).
CONCLUSIONS
Attendings in PICU programs with a fellowship have fewer opportunities to perform TI and lower first attempt success rates. Opportunities exist for attending TI skill maintenance, especially in PICUs with a PCCM fellowship.
目的
气管插管（TI）是儿科重症监护病房（PICU）主治医师需要掌握的一项关键技能。我们假设，在设有儿科重症医学（PCCM） fellowship的PICU项目中，主治医师进行气管插管的次数较少且成功率较低。
设计
使用2016年7月至2020年6月的全国儿童紧急气道登记系统（NEAR4KIDS）进行回顾性研究。暴露因素为是否设有PCCM fellowship以及主治医师气管插管技能维持项目（SMP）。主要结局是主治医师首次尝试的成功率，次要结局是首次尝试时的不良气道结局。
地点
北美的33个PICU。
患者
接受气管插管的儿童。
干预措施
无。
测量指标及主要结果
总体而言，33个PICU中有23个设有PCCM fellowship，其中23个中有3个设有主治医师气管插管SMP。主治医师进行气管插管的比例为24.1%（2,728/11,323）：设有fellowship的PICU中为13.9%（每个PICU每年13.8次气管插管），未设fellowship的PICU中为66.0%（每个PICU每年36.6次气管插管）（p < 0.001）。设有fellowship与未设fellowship的PICU中，主治医师首次尝试的成功率分别为70.5%和81.3%（差异为10.8% [95%可信区间，7.6 - 14.0%]；p < 0.0001）。在控制混杂因素后，设有fellowship的PICU中主治医师首次尝试成功的几率较低（调整后的优势比[aOR]，0.65 [95%可信区间，0.47 - 0.90]）。我们未发现主治医师首次尝试成功与PICU项目类型（设有与未设气管插管SMP）之间存在关联（74.0%对69.5%；p = 0.146）。在设有气管插管SMP与未设气管插管SMP的PICU项目中，主治医师首次尝试气管插管时的不良气道结局发生率较低（32.8%对40.3%；p = 0.020）。然而，在调整混杂因素后，我们未能排除不良结局几率几乎减半的可能性（aOR，0.75 [95%可信区间，0.55 - 1.01]；p = 0.058）。
结论
设有fellowship的PICU项目中的主治医师进行气管插管的机会较少，首次尝试成功率较低。存在进行主治医师气管插管技能维持的机会，尤其是在设有PCCM fellowship的PICU中。
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