Assessing respiratory therapists performance when it comes to intubations.

Patient Safety

How Effectively Do Respiratory Therapists Perform Endotracheal Intubation?

Videolaryngoscopy was used in 65 percent of the initial attempts and was associated with a higher first-attempt success rate, higher overall success rate and fewer adverse events, according to the study.

Respiratory therapists (RTs) have performed intubations for years, but there is little documentation assessing their performance.

A recent multicenter study, out of Duke University Medical Center, sought to evaluate the intubation outcomes of RTs compared against those of other clinicians. In addition to RTs, typically physicians, pulmonologists, anesthesiologists and nurse anesthetists are among those who perform such intubations.

The study, published in Respiratory Care, found that intubations performed by RTs had “a high success rate, with AE (adverse events) rates comparable to published results from other types of providers.”

The assessment came from data collected at two different facilities, between May 25, 2020 and April 30, 2022, based on a total of 689 intubations where RTs made an attempt. Of those, RTs were successful in 98 percent of the attempts.

Videolaryngoscopy was used in 65 percent of the initial attempts and was associated with a higher first-attempt success rate, higher overall success rate and fewer adverse events, according to the study. The most common reasons for the intubations were cardiac arrest and respiratory failure.

The airway-related adverse event rate was 8.7 percent.

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Related: A Respiratory Therapist Rises to the Challenge

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What Kind of Training Do RTs Receive?

In an earlier Respiratory Care study, also out of Duke University Medical Center, researcher Andrew G. Miller surveyed the kinds of endotracheal intubation training that RTs have received and the barriers that prevent them from performing intubations in some facilities.

The most common forms of training were simulation training and supervised endotracheal intubations, according to 74 people who completed surveys. Classroom training ranged from one hour to 16 hours.

About 91 percent were required to complete 10 or fewer supervised endotracheal intubations before their competency validation.

There were a variety of answers when it came to the endotracheal intubation recertification process. Most RTs were recertified by completing a minimum number of endotracheal intubations.

RTs who performed endotracheal intubation typically worked at facilities with larger bed capacity and more adult ICU beds. The most common reason cited for RTs not performing intubations at particular facilities was a lack of need for them to do so.

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