Respiratory Therapist Endotracheal Intubation Practices in North Carolina

Background: Endotracheal intubation is a common procedure performed by respiratory therapists (RTs). The purpose of this study is to describe current RT intubation practices in North Carolina through the use of survey instrument. Methods: A survey was developed by the authors and sent via email to all licensed RTs in North Carolina. An exemption was granted by the Duke Institutional Review Board. Questions included: respondent demographics, intubation practices (including training and skill maintenance) and attitudes about RT intubation practices. Data are presented as percentages or medians with interquartile range (IQR). Results: The survey was sent to 4,817 licensed RTs, with 411 responses from 133 unique institutions and 81 (61%) intubated at their facility. RTs who performed intubation were more likely to be from community hospitals and less likely to be from level one trauma centers. 60% of respondents defined an intubation attempt as an endotracheal tube passed through the oropharynx with 34% defining an attempt as a laryngoscope in the mouth. Respondents reported intubating adults (91%), pediatric (61%), and (65%) neonatal patients. The most common areas RTs reported performing intubation were the adult ICU (80%), ED (76%), outside the OR for emergencies (76%), neonatal ICU (43%), the delivery room (45%), and pediatric ICU (25%). Training for intubation varied among respondents with classroom training (51%), written materials (38%), written test (27%), skill demonstration in a simulation setting (85%), and supervised intubations (71%) reported as training methods. Supervised intubations were performed in the operating room (54%), ICU (68%), ED (59%), delivery room (29%), and other (23%). 84% respondents reported there was no minimum amount of experience before intubation training. The reported number of supervised intubations required to be competent was 5 (3-5). Less than 10 intubations were required by 81% of respondents. The perceived number of intubations to gain competence was 6 (range 5-10) and did not differ based on years of experience. Most respondents believed their RT intubation program was safe (93%), effective (91%), RTs were well-trained (81%), their intubation skills objectively evaluated (66%), and receive sufficient feedback on performance (68%). Conclusions: RTs in North Carolina frequently provided intubation and had high confidence in their programs. Training methods and clinical practice varied throughout the state.