Abstract
Background:
Physicians perform intubations at OSUWMC, and the demand for physicians is predicted to exceed supply in 23 states by 2030 (Zhang). Respiratory therapists (RTs) are trained to perform intubation in their curricula and already assist with intubations at OSUWMC (except the OR). They are also responsible for airway management, including securing, adjusting, maintaining, and removing (extubating) endotracheal tubes. Since RTs are staffed around the clock, trained to perform intubations, and comfortable with endotracheal tubes, they are ideal candidates to cover intubations.
Methods:
A retrospective chart review was conducted where data was collected from patient charts 3 months before and 3 months after respiratory therapists started intubating at Ohio State East Hospital. We recorded the equipment used, medications given, how many attempts it took, and who performed the intubation. A comparison of this information was made between physicians and respiratory therapists. The Office of Responsible Research Practices has determined the above referenced project exempt from IRB review.
Results:
Out of 286 charts reviewed, 215 patients, or 75.17% were intubated at Ohio State East Hospital. RTs performed a total of 23 intubations (16.95%). RTs successfully intubated in 1 attempt 86.36% of the time, and 2 attempts 9.09% of the time. Non-RTs successfully intubated in 1 attempt 68.04% of the time, 2 attempts 21.65% of the time, three or more attempts 6.9% of the time. The most common intubation equipment was the same for both groups. The McGrath was used in 39.05% of non-RT intubations and in 78.26% of RT intubations. Direct laryngoscopy was used in 27.22% of non-RT intubations and 17.39% of RT intubations. GlideScope was used in 18.93% of non-RT intubations and 0% of RT intubations. The most common medications used were the same in both groups. Etomidate and rocuronium were used in 44.72% of non-RT intubations and 55.56% on RT intubations. Etomidate and succinylcholine were used in 30.08% of non-RT intubations and 22.22% of RT intubations. Etomidate was used in 3.25% of non-RT and 11.11% of RT intubations.
Conclusions:
RTs are likely to be a suitable alternative for physicians when performing intubation. Since the top medications and equipment were identical for both groups, a protocol could be developed for greater success.
Comparisons
Method
Non-RT
Total
RT
McGrath
39.05%
43.75%
78.26%
Direct laryngoscopy
27.22%
26.04%
17.39%
GlideScope
18.93%
16.67%
0.00%
Blank
2.30%
2.54%
4.35%
Medications
Non-RT
Total
RT
Etomidate, rocuronium
44.72%
44.52%
55.56%
Etomidate, succinylcholine
30.08%
28.08%
22.22%
Etomidate
3.25%
4.11%
11.11%
Blank
26.44%
25.89%
27.78%
Number of attempts
Non-RT
Total
RT
1
68.04%
70.83%
86.36%
2
21.65%
19.17%
9.09%
3 or more
6.90%
6.09%
0.0%
Blank
43.68%
39.59%
9.09%
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