Operator anaesthesiology training and complications after endotracheal intubation in the intensive care unit: a 3-year, prospective, observational study.
OBJECTIVE
To determine whether operators with less than 3 months' formal anaesthesiology training have higher rates of complications when performing endotracheal intubation (ETI) in the intensive care unit than operators with longer formal anaesthesiology training.


METHODS
Prospective, single-centre, observational study of consecutive ETIs performed in a general, urban, tertiary ICU between May 2005 and May 2008. Data were collected by self-reported, written questionnaire.


METHODS
The two pre-defined study cohorts were ETIs performed where the initial operator had less than 3 months' formal training in anaesthesiology, and those where the initial operator had 3 months' or longer training.


METHODS
The primary outcome measure was the number of ETIs where one or more pre-defined complications occurred as a result of the ETI. Secondary outcome measures were the number of ETIs where one or more respiratory, cardiovascular or trauma complications occurred as a result of the ETI, and the number where the airway was deemed difficult by the operator.


RESULTS
Data were collected on 276 ETIs. There were no significant differences in primary or secondary outcome measures between the two main study groups. Operators with less than 3 months' formal training in anaesthesiology had a higher level of medical supervision or assistance (75% v 29%, P<0.001), more favourable patient pre-intubation oxygen saturation on pulse oximetry (SpO(2)) (76% v 65% had SpO(2)>89%, P=0.05), and easier resultant grade of intubation (70% v 56% of intubations were Grade I, P= 0.04), but required more operators (19% v 3% required two operators, P<0.001), and more attempts before ETI was successful (62% v 82% of intubations were successful on first attempt, P<0.001).


CONCLUSIONS
ETIs performed in the ICU where the initial operator has less than 3 months' formal training in anaesthesiology appear not to be associated with more complications. However, this may be attributable to less experienced operators having more assistance and supervision, and to patient selection.
Cheung
Winston
W
Intensive Care Unit, Concord Repatriation General Hospital, Sydney, NSW. winston.cheung@email.cs.nsw.gov.au
Fugaccia
Elizabeth
E
Milliss
David
D
Thanakrishnan
Govindasamy
G
D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors