Respiratory Therapist Intubation Practice in Pediatric Intensive Care Units: A Multi-Center Registry Study

Background: Endotracheal intubation by respiratory therapists (RTs) is a well-established practice and has been described primarily in adult and neonatal patients. However, minimal data exist regarding RT intubation practice in pediatric intensive care units (ICUs). The purpose of this study was to describe the current landscape of RT intubation in pediatric ICUs. Methods: A multi-center quality improvement database, the National Emergency Airway Registry for Children (NEAR4KIDs) was queried from 2015-2018. Data were prospectively collected on patient demographics, indication for intubation, difficult airway history and feature presence, provider discipline, medications and device. Intubation outcomes included first attempt and overall success rates, and tracheal intubation adverse events (TIAEs). One attempt was defined as an insertion of a device (e.g., laryngoscope) into the oropharynx. Overall intubation success was defined as tracheal intubation achieved in ≤ 2 attempts. Statistics were descriptive with Chi-squared test to compare proportions with statistical significance set at 0.05. Results: There were 12,056 initial intubation encounters analyzed, with 109 (0.9%) by RTs. Nine centers reported at least one intubation encounter by RTs. The number of RT intubation attempts per center ranged from 1 to 46 (RT attempt rate per center: 0% to 19.6%). Overall RT success rate was 76.1%, with first attempt success rate 60.6%, and adverse TIAE rate 22.9%. First attempt success rate (range 0% to 73.3%, P = .03), overall success rate (0% to 100% range P = .004), any TIAE rate (0% to 100%, P = .02) and severe TIAE rate (0 to 42.9%, P = .006) varied across centers. Three centers reported a minimum of 10 intubation attempts by RTs, with first attempt success rates of (56.0%, 71.7%, and 73.3%), overall success rates of (80.0%, 82.6%, 86.7%), and adverse TIAE rates of (36.0%, 10.9%, 33.3%). When RT attempts were compared to other providers, airway characteristics were similar except RTs were more likely to intubate children due to a neurologic indication (RT 1.9% vs. 0.8%, P