A national survey of airway management training in United States internal medicine-based critical care fellowship programs

Abstract

Background: Intensivists may be primarily responsible for airway management in non-operating room locations. Little is known of airway management training provided during fellowship.Our primary aim was to describe the current state of airway education in internal medicine-based critical care fellowship programs.

Methods: Between February 1 and April 30, 2011, program directors of all 3-year combined pulmonary/critical care and 2-year multidisciplinary critical care medicine programs in the United States were invited to complete an online survey. Contact information was obtained via FRIEDA Online (https://freida.ama-assn.org). Non-responders were sent automated reminders, were contacted by e-mail, or by telephone.

Results: The overall response proportion was 66% (111/168 programs). Sixty-four (58%) programs reported a designated airway rotation, chiefly occurring for 1 month during the first year of training. Thirty-five programs (32%)reported having a director of airway education and 78 (70%) reported incorporating simulation based airway education. Nearly all programs (95%) reported provision of supervised airway experience during fellowship. Commonly used airway management devices, including video laryngoscopes,intubating stylets, supraglottic airway devices, and fiberoptic bronchoscopes, were reportedly available to trainees. However, 73% reported < 10 uses of a supraglottic airway device, 60% < 25 uses of intubating stylets, 73% < 30 uses of a video laryngoscope, and 65% reported < 10 flexible fiberoptic intubations. Estimates of the required number of procedures to ensure competence varied widely.

Conclusions: The majority of programs have a formal airway management program incorporating a variety of intubation techniques. Overall experience varies widely, however.