title: Influence of residency training on multiple attempts at endotracheal intubation.
abstract: OBJECTIVE
  Endotracheal intubation (ETI) of critically ill patients is a high-risk procedure that is commonly performed by resident physicians. Multiple attempts (>/=2) at intubation have previously been shown to be associated with severe complications. Our goal was to determine the association between year of training, type of residency, and multiple attempts at ETI.
  
  
  METHODS
  This was a cohort study of 191 critically ill patients requiring urgent intubation at two tertiary care teaching hospitals in Vancouver, Canada. Multivariable logistic regression was used to model the association between postgraduate year (PGY) of training and multiple attempts at ETI.
  
  
  RESULTS
  The majority of ETIs were performed for respiratory failure (68.6%) from the hours of 07:00-19:00 (60.7%). Expert supervision was present for 78.5% of the intubations. Multiple attempts at ETI were required in 62%, 48%, and 34% of patients whose initial attempt was performed by PGY-1, PGY-2, and PGY-3 non-anesthesiology residents, respectively. Anesthesiology residents required multiple attempts at ETI in 15% of patients, regardless of the year of training. The multivariable model showed that both higher year of training (risk ratio [RR] 0.74; 95% confidence interval [CI] 0.54-0.93; P < 0.01) and residency training in anesthesiology (RR 0.52; 95% CI 0.20-1.0; P = 0.05) were independently associated with a decreased risk of multiple intubation attempts. Finally, intubations performed at night were associated with an increased risk of multiple intubation attempts (RR 1.3; 95% CI 1.0-1.4; P = 0.03).
  
  
  CONCLUSIONS
  Year of training, type of residency, and time of day were significantly associated with multiple tracheal intubation attempts in the critical care setting.
authors.affiliation: Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hirsch-Allen
authors.forename: Najib
authors.initials: N
authors.lastname: Ayas
authors.forename: Scot
authors.initials: S
authors.lastname: Mountain
authors.forename: Peter
authors.initials: P
authors.lastname: Dodek
authors.forename: Adam
authors.initials: A
authors.lastname: Peets
authors.forename: Donald E G
authors.initials: DE
authors.lastname: Griesdale
mesh_terms: D000328:Adult; D000368:Aged; D000776:Anesthesiology / Q000193:education; D001955:British Columbia; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods / Q000592:standards; D016638:Critical Illness; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome