Impact of Attending Physician Presence During Respiratory Therapist Intubation Attempts

Abstract

Background:

Respiratory therapists (RTs) perform endotracheal intubation in collaboration with physicians. Attending physicians may not be readily available during RT intubation attempts. We hypothesized that attending physician presence during RT intubation attempts would increase first-attempt success rate.

Methods:

We retrospectively studied intubation attempts where RTs made the initial attempt between May 2020 and March 2025. The primary outcome was first-attempt success rate, and the secondary outcome was occurrence of airway-related adverse events (AEs). We compared RT intubation attempts with and without an attending present. We performed logistic regression models for first-attempt success rate and AEs.

Results:

There were 710 RT intubation attempts, and an attending was present for 386 (54%). With an attending present, there was no difference in first-attempt (92% vs 88% P = .13) and overall (99% vs 98%, P = .20) success rate, but AEs were lower (2.8% vs 11%, P < .001). Attending presence was associated with lower RT experience level and fewer prior intubations. There were no differences in patient demographics, physiologic AEs, and cricoid pressure during attempts. Attendings were more likely to be present for intubations in the ICU or ED (73% vs 49%, P < .001) compared to other sites, and video laryngoscopy was more commonly used during the first attempt (81% vs 72%, P < .001). Attendings were less likely to be present during cardiac arrest (39% vs 57%, P < .001) and intubations in the setting of cardiopulmonary resuscitation (34% vs 51%, P < .001). Medications to assist with intubation were used less frequently when attendings were not present (42% vs 71%, P < .001). Logistic regression found no association of first-attempt success rate with attending presence (odds ratio [OR] 1.0, 95% CI [0.5–1.9], P = .94), but a lower rate of AEs (OR 0.3, 95% CI [0.1–.6], P = .004).

Conclusions:

Attending physician presence during intubation by RTs did not affect first-attempt success rate but was associated with fewer AEs.