Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Laryngoscopy | Viewpoint

A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit

Authors: Wade Brown, Lekshmi Santhosh, Anna K. Brady, Joshua L. Denson, Abesh Niroula, Meredith E. Pugh, Wesley H. Self, Aaron M. Joffe, P. O’Neal Maynord, W. Graham Carlos

Published in: Critical Care | Issue 1/2020

Login to get access

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.
Literature
1.
Griesdale DE, Bosma TL, Kurth T, Isac G, Chittock DR. Complications of endotracheal intubation in the critically ill. Intensive Care Med. 2008;34(10):1835–42.PubMedCrossRef
2.
Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med. 2006;34(9):2355–61.CrossRef
3.
Walz JM. Point: should an anesthesiologist be the specialist of choice in managing the difficult airway in the ICU? Yes. Chest. 2012;142(6):1372–4.PubMedCrossRef
4.
Brindley PG, Beed M, Law JA, et al. Airway management outside the operating room: how to better prepare. Can J Anaesth. 2017;64(5):530–9.PubMedCrossRef
5.
Asai T. Airway management inside and outside operating rooms-circumstances are quite different. Br J Anaesth. 2018;120(2):207–9.PubMedCrossRef
6.
Taboada M, Doldan P, Calvo A, et al. Comparison of tracheal intubation conditions in operating room and intensive care unit: a prospective, Observational Study. Anesthesiology. 2018;129(2):321–8.CrossRef
7.
8.
Joffe AM, Liew EC, Olivar H, et al. A national survey of airway management training in United States internal medicine-based critical care fellowship programs. Respir Care. 2012;57(7):1084–8.PubMedCrossRef
9.
Chichra A, Naval P, Dibello C, Tsegaye A, Mayo P, Koenig S, Narasimhan M. Barriers to training pulmonary and critical care fellows in emergency endotracheal intubation across the United States. Chest. 2011;140(4):1036A.CrossRef
10.
Buis ML, Maissan IM, Hoeks SE, Klimek M, Stolker RJ. Defining the learning curve for endotracheal intubation using direct laryngoscopy: a systematic review. Resuscitation. 2016;99:63–71.PubMedCrossRef
11.
Ishizuka M, Rangarajan V, Sawyer TL, et al. The development of tracheal intubation proficiency outside the operating suite during pediatric critical care medicine fellowship training: a retrospective cohort study using cumulative sum analysis. Pediatr Crit Care Med. 2016;17(7):e309–16.PubMedPubMedCentralCrossRef
12.
Je S, Cho Y, Choi HJ, Kang B, Lim T, Kang H. An application of the learning curve-cumulative summation test to evaluate training for endotracheal intubation in emergency medicine. Emerg Med J. 2015;32(4):291–4.PubMedCrossRef
13.
Brown W, Janz DR, Russell D, Joffe AM, James DM, Vonderhaar DJ, West JR, Rice TW, Semler MW, Casey JD. Effect of operator experience on outcomes of emergency airway management: the ICU intubation learning curve. Am J Respir Crit Care Med. 2019;199:A5985.
14.
Bernhard M, Mohr S, Weigand MA, Martin E, Walther A. Developing the skill of endotracheal intubation: implication for emergency medicine. Acta Anaesthesiol Scand. 2012;56(2):164–71.PubMedCrossRef
15.
Kim SY, Park SO, Kim JW, et al. How much experience do rescuers require to achieve successful tracheal intubation during cardiopulmonary resuscitation? Resuscitation. 2018;133:187–92.PubMedCrossRef
16.
De Oliveira Filho GR. The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method. Anesth Analg. 2002;95(2):411–6 table of contents.PubMed
17.
Schebesta K, Hüpfl M, Rössler B, Ringl H, Müller MP, Kimberger O. Degrees of reality: airway anatomy of high-fidelity human patient simulators and airway trainers. Anesthesiology. 2012;116(6):1204–9.PubMedCrossRef
18.
Klock PA. Airway simulators and mannequins: a case of high infidelity? Anesthesiology. 2012;116(6):1179–80.PubMedCrossRef
19.
Wong W, Kedarisetty S, Delson N, et al. The effect of cross-training with adjustable airway model anatomies on laryngoscopy skill transfer. Anesth Analg. 2011;113(4):862–8.PubMedCrossRef
20.
Sun Y, Pan C, Li T, Gan TJ. Airway management education: simulation based training versus non-simulation based training-a systematic review and meta-analyses. BMC Anesthesiol. 2017;17(1):17.PubMedPubMedCentralCrossRef
21.
Yang D, Wei YK, Xue FS, Deng XM, Zhi J. Simulation-based airway management training: application and looking forward. J Anesth. 2016;30(2):284–9.PubMedCrossRef
22.
Barsuk JH, Cohen ER, Feinglass J, Mcgaghie WC, Wayne DB. Residents’ procedural experience does not ensure competence: a research synthesis. J Grad Med Educ. 2017;9(2):201–8.PubMedPubMedCentralCrossRef
23.
Jaber S, Jung B, Corne P, et al. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med. 2010;36(2):248–55.PubMedCrossRef
24.
Mosier JM, Malo J, Sakles JC, et al. The impact of a comprehensive airway management training program for pulmonary and critical care medicine fellows. A three-year experience. Ann Am Thorac Soc. 2015;12(4):539–48.PubMedCrossRef
25.
Malo J, Hypes C, Natt B, Cristan E, Greenberg J, Morrissette K, Snyder L, Knepler J, Sakles J, Knox K, Mosier J. Airway registry and training curriculum improve intubation outcomes in the intensive care unit. Southwest J Pulm Crit Care. 2018;16(4):212–23.
26.
Barsuk JH, Cohen ER, Potts S, et al. Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections. BMJ Qual Saf. 2014;23(9):749–56.PubMedCrossRef
27.
Barsuk JH, Cohen ER, Caprio T, Mcgaghie WC, Simuni T, Wayne DB. Simulation-based education with mastery learning improves residents’ lumbar puncture skills. Neurology. 2012;79(2):132–7.PubMedPubMedCentralCrossRef
28.
Petrosoniak A, Lu M, Gray S, et al. Perfecting practice: a protocol for assessing simulation-based mastery learning and deliberate practice versus self-guided practice for bougie-assisted cricothyroidotomy performance. BMC Med Educ. 2019;19(1):100.PubMedPubMedCentralCrossRef
29.
Mayo PH, Hegde A, Eisen LA, Kory P, Doelken P. A program to improve the quality of emergency endotracheal intubation. J Intensive Care Med. 2011;26(1):50–6.PubMedCrossRef
30.
Volz S, Stevens TP, Dadiz R. A randomized controlled trial: does coaching using video during direct laryngoscopy improve residents’ success in neonatal intubations? J Perinatol. 2018;38(8):1074–80.PubMedCrossRef
31.
Hackmann H, Leonard D, Anderson JM. Expert modeling improves the acquisition of technical and behavioral skills in neonatal resuscitation training. Washington, D.C: Poster presented at: American Academy of Pediatrics National Conference and Exhibition; 2009.
32.
Gilhooly J, Redden HR, Leonard DT. Competency in neonatal endotracheal intubation: mission impossible? Pediatrics. 2015;135(5):e1290–1.PubMedCrossRef
33.
Kardash K, Tessler MJ. Videotape feedback in teaching laryngoscopy. Can J Anaesth. 1997;44(1):54–8.PubMedCrossRef
34.
Doerschug KC. Counterpoint: should an anesthesiologist be the specialist of choice in managing the difficult airway in the ICU? Not necessarily. Chest. 2012;142(6):1375–7.PubMedCrossRef
35.
Levitan RM, Rosenblatt B, Meiner EM, Reilly PM, Hollander JE. Alternating day emergency medicine and anesthesia resident responsibility for management of the trauma airway: a study of laryngoscopy performance and intubation success. Ann Emerg Med. 2004;43(1):48–53.PubMedCrossRef
36.
Bushra JS, Mcneil B, Wald DA, Schwell A, Karras DJ. A comparison of trauma intubations managed by anesthesiologists and emergency physicians. Acad Emerg Med. 2004;11(1):66–70.PubMedCrossRef
37.
38.
39.
Kovitz KL. Three cheers for the crumbling silo: the lesson of how a minor procedure can have a major impact. Chest. 2013;144(2):368–9.PubMedCrossRef
40.
October TW, Dizon ZB, Hamilton MF, Madrigal VN, Arnold RM. Communication training for inter-specialty clinicians. Clin Teach. 2019;16(3):242–7.PubMedCrossRef
41.
Fouche PF, Middleton PM, Zverinova KM. Training and experience are more important than the type of practitioner for intubation success. Crit Care. 2013;17(1):412.PubMedPubMedCentralCrossRef
42.
Moureau N, Lamperti M, Kelly LJ, et al. Evidence-based consensus on the insertion of central venous access devices: definition of minimal requirements for training. Br J Anaesth. 2013;110(3):347–56.PubMedCrossRef
43.
Akhtar S, Theodoro D, Gaspari R, et al. Resident training in emergency ultrasound: consensus recommendations from the 2008 Council of Emergency Medicine Residency Directors Conference. Acad Emerg Med. 2009;16(Suppl 2):S32–6.PubMedCrossRef
44.
Ernst A, Wahidi MM, Read CA, et al. Adult bronchoscopy training: current state and suggestions for the future: CHEST expert panel report. Chest. 2015;148(2):321–32.PubMedPubMedCentralCrossRef
45.
Gowens P, Aitken-Fell P, Broughton W, Harris L, Williams J, Younger P, Bywater D, Crookston C, Curatolo L, Edwards T, Freshwater E, House M, Jones A, Millins M, Pilbery R, Standen S, Wiggin C. Consensus statement: a framework for safe and effective intubation by paramedics. BPJ. 2018;3(1):23–7.CrossRef
46.
Voduc N, Adamson R, Kashgari A, et al. Development of learning curves for bronchoscopy results of a multicentre study of pulmonary trainees. Chest. 2020;S0012–3692(20):31840–7.
Metadata
Title
A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit
Authors
Wade Brown
Lekshmi Santhosh
Anna K. Brady
Joshua L. Denson
Abesh Niroula
Meredith E. Pugh
Wesley H. Self
Aaron M. Joffe
P. O’Neal Maynord
W. Graham Carlos
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03317-3

Other articles of this Issue 1/2020

Critical Care 1/2020 Go to the issue

Letter

Infliximab can reduce mortality from 35 to 14% in critically ill patients with COVID-19: perhaps some potential confounders to consider

Commentary

Interferon beta-1a for COVID-19: critical importance of the administration route

Research

Early hyperoxemia is associated with lower adjusted mortality after severe trauma: results from a French registry

Research

Association between incident delirium and 28- and 90-day mortality in critically ill adults: a secondary analysis

Research

The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study

Research Letter

A plea for avoiding systematic intubation in severely hypoxemic patients with COVID-19-associated respiratory failure