title: The impact of a comprehensive airway management training program for pulmonary and critical care medicine fellows. A three-year experience.
abstract: BACKGROUND
  Airway management in the intensive care unit (ICU) is challenging, as many patients have limited physiologic reserve and are at risk for clinical deterioration if the airway is not quickly secured. In academic medical centers, ICU intubations are often performed by trainees, making airway management education paramount for pulmonary and critical care trainees.
  
  
  OBJECTIVE
  To improve airway management education for our trainees, we developed a comprehensive training program including an 11-month simulation-based curriculum. The curriculum emphasizes recognition of and preparation for potentially difficult intubations and procedural skills to maximize patient safety and increase the likelihood of first-attempt success.
  
  
  METHODS
  Training is provided in small group sessions twice monthly using a high-fidelity simulation program under the guidance of a core group of two to three advanced providers. The curriculum is designed with progressively more difficult scenarios requiring critical planning and execution of airway management by the trainees. Trainees consider patient position, preoxygenation, optimization of hemodynamics, choice of induction agents, selection of appropriate devices for the scenario, anticipation of difficulties, back-up plans, and immediate postintubation management. Clinical performance is monitored through a continuous quality improvement program.
  
  
  RESULTS
  Sixteen fellows have completed the program since July 1, 2013. In the 18 months since the start of the curriculum (July 1, 2013-December 31, 2014), first-attempt success has improved from 74% (358/487) to 82% (305/374) compared with the 18 months before implementation (P = 0.006). During that time there were no serious complications related to airway management. Desaturation rates decreased from 26 to 17% (P = 0.002). Other complication rates are low, including aspiration (2.1%), esophageal intubation (2.7%), dental trauma (0.8%), and hypotension (8.3%). First-attempt success in a 6-month period after implementation (July 1, 2014-December 31, 2014) was significantly higher (82.1 compared with 70.9%, P = 0.03) than during a similar 6-month period before implementation (July 1, 2012-December 31, 2012).
  
  
  CONCLUSIONS
  This comprehensive airway curriculum is associated with improved first-attempt success rate for intensive care unit intubations. Such a curriculum holds the potential to improve patient care.
authors.affiliation: 1 Division of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, and.
authors.forename: Jarrod M
authors.initials: JM
authors.lastname: Mosier
authors.forename: Joshua
authors.initials: J
authors.lastname: Malo
authors.forename: John C
authors.initials: JC
authors.lastname: Sakles
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Hypes
authors.forename: Bhupinder
authors.initials: B
authors.lastname: Natt
authors.forename: Linda
authors.initials: L
authors.lastname: Snyder
authors.forename: James
authors.initials: J
authors.lastname: Knepler
authors.forename: John W
authors.initials: JW
authors.lastname: Bloom
authors.forename: Raj
authors.initials: R
authors.lastname: Joshi
authors.forename: Kenneth
authors.initials: K
authors.lastname: Knox
mesh_terms: D000368:Aged; D058109:Airway Management; D002983:Clinical Competence; D003422:Critical Care; D003479:Curriculum; D005257:Fellowships and Scholarships / Q000379:methods*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy / Q000193:education*; D008297:Male; D008875:Middle Aged; D015272:Pulmonary Medicine / Q000193:education*; D000066908:Simulation Training / Q000379:methods*
keywords: airway management; education; intensive care; intubation; simulation