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Intubation by
Pediatric Residents
Reviewed by: Mark L. Hudak MD
Leone TA, Rich W, Finer NN. Neonatal intubation: Success of pediatric trainees. J Pediatr 2005; 146: 638-641.
Study design: We
reviewed a database of all neonatal intubations designed as a quality assurance
process at our institution. Respiratory care practitioners recorded the number
of attempts at the time of each procedure. Attempts were defined as each time a
laryngoscope was placed in the baby's mouth. Success rates were calculated as
the number of successful intubations divided by the attempts.
Results: From January 1992 through September 2002, 5051 successful
intubations with 9190 attempts were performed by all practitioners. Pediatric
residents intubated neonates successfully on 1676 occasions requiring 3719
attempts. The median success rates were 33% for pediatric level (PL)1 residents;
40% for PL2 and PL3 residents, and 68% for neonatal fellows (P < .001).
The success rates for residents who had more than 20 total attempts versus those
who had fewer than 20 attempts were 49% versus 37% (P < .001).
Conclusions: Developing proficiency at intubation requires a significant
amount of experience. Current pediatric residents at our institution have
inadequate opportunity to achieve consistent success.
Comment: This study surprises none of us. I would suggest that the technical ability to intubate tracks along not only with other technical skills (e.g., intravenous access, umbilical line procedures, chest tube insertion) but also with the ability of residents/fellows to recognize a sick baby or a significant change in clinical condition. And we cannot suppose that the ongoing evolution of residency training program requirements will make this situation better. Perhaps someday the NICU will become a “show and tell” rotation. In any case, I think all of us can be assured of having a job until well into our 80’s if our minds and bodies can hold out that long. MLH.
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