Nationwide survey on training and device utilization during tracheal intubation in French intensive care units

M Martin,C Garret,P Decamps,J B Lascarrou,E Canet,O Zambon,L Crosby,A Seguin,A F Miailhe,J Reignier

doi:10.1186/s13613-019-0621-9

Abstract

BackgroundIntubation is a lifesaving procedure that is often performed in intensive care unit (ICU) patients, but leads to serious adverse events in 20–40% of cases. Recent trials aimed to provide guidance about which medications, devices, and modalities maximize patient safety. Videolaryngoscopes are being offered in an increasing range of options and used in broadening indications (from difficult to unremarkable intubation). The objective of this study was to describe intubation practices and device availability in French ICUs.Materials and methodsWe conducted an online nationwide survey by emailing an anonymous 26-item questionnaire to physicians in French ICUs. A single questionnaire was sent to either the head or the intubation expert at each ICU.ResultsOf 257 ICUs, 180 (70%) returned the completed questionnaire. The results showed that 43% of intubators were not fully proficient in intubation; among them, 18.8% had no intubation training or had received only basic training (lectures and observation at the bedside). Among the participating ICUs, 94.4% had a difficult intubation trolley, 74.5% an intubation protocol, 92.2% a capnography device (used routinely to check tube position in 69.3% of ICUs having the device), 91.6% a laryngeal mask, 97.2% front-of-neck access capabilities, and 76.6% a videolaryngoscope. In case of difficult intubation, 85.6% of ICUs used a bougie (154/180) and 7.8% switched to a videolaryngoscope (14/180). Use of a videolaryngoscope was reserved for difficult intubation in 84% of ICUs (154/180). Having a videolaryngoscope was significantly associated with having an intubation protocol (P = 0.043) and using capnography (P = 0.02). Airtraq® was the most often used videolaryngoscope (39.3%), followed by McGrath®Mac (36.9%) then by Glidescope® (14.5%).ConclusionNearly half the intubators in French ICUs are not fully proficient with OTI. Access to modern training methods such as simulation is inadequate. Most ICUs own a videolaryngoscope, but reserve it for difficult intubations.

Highlights

Many factors contribute to the considerable morbidity and mortality associated with orotracheal intubation (OTI) in critically ill patients [1]
The results showed that 43% of intubators were not fully proficient in intubation; among them, 18.8% had no intubation training or had received only basic training
In case of difficult intubation, 85.6% of intensive care unit (ICU) used a bougie (154/180) and 7.8% switched to a videolaryngoscope (14/180)

Summary

Introduction

Many factors contribute to the considerable morbidity and mortality associated with orotracheal intubation (OTI) in critically ill patients [1]. OTI conditions should be optimized by careful attention to patient installation, prediction of difficult intubation based on the MACOCHA score [2], the application of appropriate algorithms [8], neuromuscular blockade, and the routine use of capnography to check endotracheal tube position. Combining these measures within a routinely applied protocol decreases the frequency of severe complications [1]. Intubation is a lifesaving procedure that is often performed in intensive care unit (ICU) patients, but leads to serious adverse events in 20–40% of cases. The objective of this study was to describe intubation practices and device availability in French ICUs

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Discussion

Conclusion