Downward trend in pediatric resident laryngoscopy participation in PICUs

National Emergency Airway Registry for Children (NEAR4KIDS); Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

doi:10.1097/PCC.0000000000001470

Downward trend in pediatric resident laryngoscopy participation in PICUs

National Emergency Airway Registry for Children (NEAR4KIDS), Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

Objectives: As of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency in nonneonatal tracheal intubation. We hypothesized that laryngoscopy by pediatric residents has decreased over time, with a more pronounced decrease after this guideline change. Design: Prospective cohort study. Setting: Twenty-five PICUs at various children's hospitals across the United States. Patients: Tracheal intubations performed in PICUs from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children). Intervention: None. Measurements and Main Results: Prospective cohort study in which all primary tracheal intubations occurring in the United States from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children) were analyzed. Participating PICU leaders were also asked to describe their local airway management training for residents. Resident participation trends over time, stratified by presence of a Pediatric Critical Care Medicine fellowship and airway training curriculum for residents, were described. A total of 9,203 tracheal intubations from 25 PICUs were reported. Pediatric residents participated in 16% of tracheal intubations as first laryngoscopists: 14% in PICUs with a Pediatric Critical Care Medicine fellowship and 34% in PICUs without one (p < 0.001). Resident participation decreased significantly over time (3.4% per year; p < 0.001). The decrease was significant in ICUs with a Pediatric Critical Care Medicine fellowship (p < 0.001) but not in ICUs without one (p = 0.73). After adjusting for site-level clustering, patient characteristics, and Pediatric Critical Care Medicine fellowship presence, the Accreditation Council for Graduate Medical Education guideline change was not associated with lower participation by residents (odds ratio, 0.86; 95% CI, 0.59-1.24; p = 0.43). The downward trend of resident participation was similar regardless of the presence of an airway curriculum for residents. Conclusion: Laryngoscopy by pediatric residents has substantially decreased over time. This downward trend was not associated with the 2013 Accreditation Council for Graduate Medical Education change in residency requirements.

Original language	English (US)
Pages (from-to)	E242-E250
Journal	Pediatric Critical Care Medicine
Volume	19
Issue number	5
DOIs	https://doi.org/10.1097/PCC.0000000000001470
State	Published - May 2018
Externally published	Yes

Keywords

Accreditation Council for Graduate Medical Education
Pediatric intensive care unit
Resident
Tracheal intubation

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Critical Care and Intensive Care Medicine

Access to Document

10.1097/PCC.0000000000001470

Cite this

@article{494e445f8c164592b070d9779c4a117d,

title = "Downward trend in pediatric resident laryngoscopy participation in PICUs",

abstract = "Objectives: As of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency in nonneonatal tracheal intubation. We hypothesized that laryngoscopy by pediatric residents has decreased over time, with a more pronounced decrease after this guideline change. Design: Prospective cohort study. Setting: Twenty-five PICUs at various children's hospitals across the United States. Patients: Tracheal intubations performed in PICUs from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children). Intervention: None. Measurements and Main Results: Prospective cohort study in which all primary tracheal intubations occurring in the United States from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children) were analyzed. Participating PICU leaders were also asked to describe their local airway management training for residents. Resident participation trends over time, stratified by presence of a Pediatric Critical Care Medicine fellowship and airway training curriculum for residents, were described. A total of 9,203 tracheal intubations from 25 PICUs were reported. Pediatric residents participated in 16% of tracheal intubations as first laryngoscopists: 14% in PICUs with a Pediatric Critical Care Medicine fellowship and 34% in PICUs without one (p < 0.001). Resident participation decreased significantly over time (3.4% per year; p < 0.001). The decrease was significant in ICUs with a Pediatric Critical Care Medicine fellowship (p < 0.001) but not in ICUs without one (p = 0.73). After adjusting for site-level clustering, patient characteristics, and Pediatric Critical Care Medicine fellowship presence, the Accreditation Council for Graduate Medical Education guideline change was not associated with lower participation by residents (odds ratio, 0.86; 95% CI, 0.59-1.24; p = 0.43). The downward trend of resident participation was similar regardless of the presence of an airway curriculum for residents. Conclusion: Laryngoscopy by pediatric residents has substantially decreased over time. This downward trend was not associated with the 2013 Accreditation Council for Graduate Medical Education change in residency requirements.",

keywords = "Accreditation Council for Graduate Medical Education, Pediatric intensive care unit, Resident, Tracheal intubation",

author = "{National Emergency Airway Registry for Children (NEAR4KIDS)} and {Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)} and Aayush Gabrani and Taiki Kojima and Sanders, {Ronald C.} and Asha Shenoi and Vicki Montgomery and Parsons, {Simon J.} and Sandeep Gangadharan and Sholeen Nett and Natalie Napolitano and Keiko Tarquinio and Simon, {Dennis W.} and Anthony Lee and Guillaume Emeriaud and Michelle Adu-Darko and Giuliano, {John S.} and Keith Meyer and Graciano, {Ana Lia} and Turner, {David A.} and Conrad Krawiec and Bakar, {Adnan M.} and Polikoff, {Lee A.} and Margaret Parker and Ilana Harwayne-Gidansky and Benjamin Crulli and Paula Vanderford and Breuer, {Ryan K.} and Eleanor Gradidge and Aline Branca and Grater-Welt, {Lily B.} and David Tellez and Wright, {Lisa V.} and Matthew Pinto and Vinay Nadkarni and Akira Nishisaki",

note = "Funding Information: Supported, in part, by Agency for Healthcare Research and Quality (AHRQ): AHRQ R03HS021583, AHRQ R18HS022464, R18HS024511, and Endowed Chair, Critical Care Medicine, The Children's Hospital of Philadelphia. Drs. Napolitano, Nadkarni, and Nishisaki were supported by grants AHRQ R18HS022464, R18HS024511, and AHRQ R03HS021583. Dr. Napolitano also received grants from Aerogen, Nihon Kohden, Philips/ Respironics, Draeger Medical, and CVS Health, and consulting/speaking agreements with Aerogen, Draeger, Actuated Medical, GeNO LLC, and Smiths Medical. Her institution received funding from research relationships with Draeger, Aerogen, Smiths Medical, GeNO, Philips Respironics, and actuated Medical and from grant support R21 and R18 from Eunice Kennedy Shriver National Institute of Child Health and Human Development and Agency for Healthcare Research and Quality (AHRQ). She received funding from reimbursement for travel only for board positions for American Association for Respiratory Care and Allergy and Asthma Network. Dr. Emeriaud's institution received funding from a young investigator grant of the Respiratory Health Network of the Fonds de Recherche du Quebec-Sant{\'e} and from a Clinical Research Scholarship of the Fonds de Recherche du Quebec - Sante. Dr. Polikoff received funding from Roche Pharmaceuticals. Dr. Parker received funding from Raynes McCarty. Dr. Glater-Welt received funding from the National Institutes of Health. Dr. Nishisaki institution received funding from AHRQ R03HS021583, R18HS022464, and R18HS024511, and he received support for article research from the AHRQ. The remaining authors have disclosed that they do not have any potential conflicts of interest. Funding Information: Supported, in part, by Agency for Healthcare Research and Quality (AHRQ): AHRQ R03HS021583, AHRQ R18HS022464, R18HS024511, and Endowed Chair, Critical Care Medicine, The Children{\textquoteright}s Hospital of Philadelphia. Drs. Napolitano, Nadkarni, and Nishisaki were supported by grants AHRQ R18HS022464, R18HS024511, and AHRQ R03HS021583. Funding Information: Dr. Napolitano also received grants from Aerogen, Nihon Kohden, Philips/ Respironics, Draeger Medical, and CVS Health, and consulting/speaking agreements with Aerogen, Draeger, Actuated Medical, GeNO LLC, and Smiths Medical. Her institution received funding from research relationships with Draeger, Aerogen, Smiths Medical, GeNO, Philips Respironics, and actuated Medical and from grant support R21 and R18 from Eunice Ken- Agency for Healthcare Research and Quality (AHRQ). She received fundingnedy ShriverNational Institute of Child Health and Human Development and racheal intubation (TI) is a life-saving procedure in from reimbursement for travel only for board positions for American Associa- critically ill infants and children (1). Critically ill chil-tion for Respiratory Care and Allergy and Asthma Network. Dr. Emeriaud{\textquoteright}s Tdren often have challenging airway anatomy, low oxy-tory Health Network of the Fonds de Recherche du Quebec-Sant{\'e} and frominstitution received funding from a young investigator grant of the Respira- gen reserve, or life-threatening hemodynamic instability that a Clinical Research Scholarship of the Fonds de Recherche du Quebec – places them at high risk for TI-associated adverse events. These Sante. Dr. Polikoff received funding from Roche Pharmaceuticals. Dr. Parker challenges, coupled with the low frequency of pediatric trainee from the National Institutes of Health. Dr. Nishisaki institution received fundingreceived funding from Raynes McCarty. Dr. Glater-Welt received funding exposure to airway management, make TI procedural compe-from AHRQ R03HS021583, R18HS022464, and R18HS024511, and he tency difficult to achieve. received support for article research from the AHRQ. The remaining authors Published TI participation and success rates of pediatric have disclosed that they do not have any potential conflicts of interest. residents have been suboptimal: approximately 20–30% for For information regarding this article, E-mail: Nishisaki@email.chop.edu participation and 30–50% for success, respectively (1–3). Our previous study across 15 PICUs showed that resident-level pro-Objectives: As of July 2013, pediatric resident trainee guidelines vider TI success is lower and that adverse TI-associated events in the United States no longer require proficiency in nonneonatal are significantly higher when compared with fellow-level pro-tracheal intubation. We hypothesized that laryngoscopy by pedi- viders (2). These findings were thought to be due to limited atric residents has decreased over time, with a more pronounced exposure and lack of structured airway management training decrease after this guideline change. for pediatric resident trainees. Design: Prospective cohort study. Pediatric residents are expected to achieve competence in Setting: Twenty-five PICUs at various children{\textquoteright}s hospitals across specific procedures by the end of residency training in the the United States. United States (4). A recent update in the Accreditation Council Patients: Tracheal intubations performed in PICUs from July 2010 for Graduate Medical Education (ACGME) guidelines (effec-to June 2016 in the multicenter tracheal intubation database tive from July 2013) eliminated the requirement for non-(National Emergency Airway Registry for Children). neonatal TI, while retaining the requirement of neonatal TI Intervention: None. proficiency (5). Measurements and Main Results: Prospective cohort study in With the recent change in ACGME guidelines eliminat-which all primary tracheal intubations occurring in the United ing nonneonatal TI requirement, both resident participation States from July 2010 to June 2016 in the multicenter tracheal and success rates in PICU TIs may have substantially declined. intubation database (National Emergency Airway Registry for Chil- However, since the 2013 ACGME guideline change, there has dren) were analyzed. Participating PICU leaders were also asked been limited information describing the trend of pediatric to describe their local airway management training for residents. resident TI participation and first-attempt success rates in a Resident participation trends over time, stratified by presence of wide range of PICUs across the United States. Given that the a Pediatric Critical Care Medicine fellowship and airway training local needs for pediatricians{\textquoteright} technical skills are variable across curriculum for residents, were described. A total of 9,203 tracheal the United States, it is possible that some pediatric residency intubations from 25 PICUs were reported. Pediatric residents par- programs continue training for nonneonatal TIs. ticipated in 16% of tracheal intubations as first laryngoscopists: The study{\textquoteright}s primary aim is to describe the trend of pediatric 14% in PICUs with a Pediatric Critical Care Medicine fellowship resident TI participation over time and first-attempt success and 34% in PICUs without one (p < 0.001). Resident participa-rates in a wide range of PICUs across the United States using an tion decreased significantly over time (3.4% per year; p < 0.001). existing large quality improvement TI safety database: National The decrease was significant in ICUs with a Pediatric Critical Emergency Airway Registry for Children (NEAR4KIDS). This Care Medicine fellowship (p < 0.001) but not in ICUs without one study also aims to explore the association between resident (p = 0.73). After adjusting for site-level clustering, patient char-participation and training structure, including the presence of acteristics, and Pediatric Critical Care Medicine fellowship pres- a Pediatric Critical Care Medicine (PCCM) fellowship and the ence, the Accreditation Council for Graduate Medical Education existence of an airway management training curriculum for guideline change was not associated with lower participation by residents. residents (odds ratio, 0.86; 95% CI, 0.59–1.24; p = 0.43). The Our specific hypothesis was that the participation of pedi-downward trend of resident participation was similar regardless of atric residents in TIs as first laryngoscopists has declined over the presence of an airway curriculum for residents. time, and that the 2013 ACGME residency requirement change Publisher Copyright: Copyright {\textcopyright} 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies",

year = "2018",

month = may,

doi = "10.1097/PCC.0000000000001470",

language = "English (US)",

volume = "19",

pages = "E242--E250",

journal = "Pediatric Critical Care Medicine",

issn = "1529-7535",

publisher = "Lippincott Williams and Wilkins",

number = "5",

}

TY - JOUR

T1 - Downward trend in pediatric resident laryngoscopy participation in PICUs

AU - National Emergency Airway Registry for Children (NEAR4KIDS)

AU - Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

AU - Gabrani, Aayush

AU - Kojima, Taiki

AU - Sanders, Ronald C.

AU - Shenoi, Asha

AU - Montgomery, Vicki

AU - Parsons, Simon J.

AU - Gangadharan, Sandeep

AU - Nett, Sholeen

AU - Napolitano, Natalie

AU - Tarquinio, Keiko

AU - Simon, Dennis W.

AU - Lee, Anthony

AU - Emeriaud, Guillaume

AU - Adu-Darko, Michelle

AU - Giuliano, John S.

AU - Meyer, Keith

AU - Graciano, Ana Lia

AU - Turner, David A.

AU - Krawiec, Conrad

AU - Bakar, Adnan M.

AU - Polikoff, Lee A.

AU - Parker, Margaret

AU - Harwayne-Gidansky, Ilana

AU - Crulli, Benjamin

AU - Vanderford, Paula

AU - Breuer, Ryan K.

AU - Gradidge, Eleanor

AU - Branca, Aline

AU - Grater-Welt, Lily B.

AU - Tellez, David

AU - Wright, Lisa V.

AU - Pinto, Matthew

AU - Nadkarni, Vinay

AU - Nishisaki, Akira

N1 - Funding Information: Supported, in part, by Agency for Healthcare Research and Quality (AHRQ): AHRQ R03HS021583, AHRQ R18HS022464, R18HS024511, and Endowed Chair, Critical Care Medicine, The Children's Hospital of Philadelphia. Drs. Napolitano, Nadkarni, and Nishisaki were supported by grants AHRQ R18HS022464, R18HS024511, and AHRQ R03HS021583. Dr. Napolitano also received grants from Aerogen, Nihon Kohden, Philips/ Respironics, Draeger Medical, and CVS Health, and consulting/speaking agreements with Aerogen, Draeger, Actuated Medical, GeNO LLC, and Smiths Medical. Her institution received funding from research relationships with Draeger, Aerogen, Smiths Medical, GeNO, Philips Respironics, and actuated Medical and from grant support R21 and R18 from Eunice Kennedy Shriver National Institute of Child Health and Human Development and Agency for Healthcare Research and Quality (AHRQ). She received funding from reimbursement for travel only for board positions for American Association for Respiratory Care and Allergy and Asthma Network. Dr. Emeriaud's institution received funding from a young investigator grant of the Respiratory Health Network of the Fonds de Recherche du Quebec-Santé and from a Clinical Research Scholarship of the Fonds de Recherche du Quebec - Sante. Dr. Polikoff received funding from Roche Pharmaceuticals. Dr. Parker received funding from Raynes McCarty. Dr. Glater-Welt received funding from the National Institutes of Health. Dr. Nishisaki institution received funding from AHRQ R03HS021583, R18HS022464, and R18HS024511, and he received support for article research from the AHRQ. The remaining authors have disclosed that they do not have any potential conflicts of interest. Funding Information: Supported, in part, by Agency for Healthcare Research and Quality (AHRQ): AHRQ R03HS021583, AHRQ R18HS022464, R18HS024511, and Endowed Chair, Critical Care Medicine, The Children’s Hospital of Philadelphia. Drs. Napolitano, Nadkarni, and Nishisaki were supported by grants AHRQ R18HS022464, R18HS024511, and AHRQ R03HS021583. Funding Information: Dr. Napolitano also received grants from Aerogen, Nihon Kohden, Philips/ Respironics, Draeger Medical, and CVS Health, and consulting/speaking agreements with Aerogen, Draeger, Actuated Medical, GeNO LLC, and Smiths Medical. Her institution received funding from research relationships with Draeger, Aerogen, Smiths Medical, GeNO, Philips Respironics, and actuated Medical and from grant support R21 and R18 from Eunice Ken- Agency for Healthcare Research and Quality (AHRQ). She received fundingnedy ShriverNational Institute of Child Health and Human Development and racheal intubation (TI) is a life-saving procedure in from reimbursement for travel only for board positions for American Associa- critically ill infants and children (1). Critically ill chil-tion for Respiratory Care and Allergy and Asthma Network. Dr. Emeriaud’s Tdren often have challenging airway anatomy, low oxy-tory Health Network of the Fonds de Recherche du Quebec-Santé and frominstitution received funding from a young investigator grant of the Respira- gen reserve, or life-threatening hemodynamic instability that a Clinical Research Scholarship of the Fonds de Recherche du Quebec – places them at high risk for TI-associated adverse events. These Sante. Dr. Polikoff received funding from Roche Pharmaceuticals. Dr. Parker challenges, coupled with the low frequency of pediatric trainee from the National Institutes of Health. Dr. Nishisaki institution received fundingreceived funding from Raynes McCarty. Dr. Glater-Welt received funding exposure to airway management, make TI procedural compe-from AHRQ R03HS021583, R18HS022464, and R18HS024511, and he tency difficult to achieve. received support for article research from the AHRQ. The remaining authors Published TI participation and success rates of pediatric have disclosed that they do not have any potential conflicts of interest. residents have been suboptimal: approximately 20–30% for For information regarding this article, E-mail: Nishisaki@email.chop.edu participation and 30–50% for success, respectively (1–3). Our previous study across 15 PICUs showed that resident-level pro-Objectives: As of July 2013, pediatric resident trainee guidelines vider TI success is lower and that adverse TI-associated events in the United States no longer require proficiency in nonneonatal are significantly higher when compared with fellow-level pro-tracheal intubation. We hypothesized that laryngoscopy by pedi- viders (2). These findings were thought to be due to limited atric residents has decreased over time, with a more pronounced exposure and lack of structured airway management training decrease after this guideline change. for pediatric resident trainees. Design: Prospective cohort study. Pediatric residents are expected to achieve competence in Setting: Twenty-five PICUs at various children’s hospitals across specific procedures by the end of residency training in the the United States. United States (4). A recent update in the Accreditation Council Patients: Tracheal intubations performed in PICUs from July 2010 for Graduate Medical Education (ACGME) guidelines (effec-to June 2016 in the multicenter tracheal intubation database tive from July 2013) eliminated the requirement for non-(National Emergency Airway Registry for Children). neonatal TI, while retaining the requirement of neonatal TI Intervention: None. proficiency (5). Measurements and Main Results: Prospective cohort study in With the recent change in ACGME guidelines eliminat-which all primary tracheal intubations occurring in the United ing nonneonatal TI requirement, both resident participation States from July 2010 to June 2016 in the multicenter tracheal and success rates in PICU TIs may have substantially declined. intubation database (National Emergency Airway Registry for Chil- However, since the 2013 ACGME guideline change, there has dren) were analyzed. Participating PICU leaders were also asked been limited information describing the trend of pediatric to describe their local airway management training for residents. resident TI participation and first-attempt success rates in a Resident participation trends over time, stratified by presence of wide range of PICUs across the United States. Given that the a Pediatric Critical Care Medicine fellowship and airway training local needs for pediatricians’ technical skills are variable across curriculum for residents, were described. A total of 9,203 tracheal the United States, it is possible that some pediatric residency intubations from 25 PICUs were reported. Pediatric residents par- programs continue training for nonneonatal TIs. ticipated in 16% of tracheal intubations as first laryngoscopists: The study’s primary aim is to describe the trend of pediatric 14% in PICUs with a Pediatric Critical Care Medicine fellowship resident TI participation over time and first-attempt success and 34% in PICUs without one (p < 0.001). Resident participa-rates in a wide range of PICUs across the United States using an tion decreased significantly over time (3.4% per year; p < 0.001). existing large quality improvement TI safety database: National The decrease was significant in ICUs with a Pediatric Critical Emergency Airway Registry for Children (NEAR4KIDS). This Care Medicine fellowship (p < 0.001) but not in ICUs without one study also aims to explore the association between resident (p = 0.73). After adjusting for site-level clustering, patient char-participation and training structure, including the presence of acteristics, and Pediatric Critical Care Medicine fellowship pres- a Pediatric Critical Care Medicine (PCCM) fellowship and the ence, the Accreditation Council for Graduate Medical Education existence of an airway management training curriculum for guideline change was not associated with lower participation by residents. residents (odds ratio, 0.86; 95% CI, 0.59–1.24; p = 0.43). The Our specific hypothesis was that the participation of pedi-downward trend of resident participation was similar regardless of atric residents in TIs as first laryngoscopists has declined over the presence of an airway curriculum for residents. time, and that the 2013 ACGME residency requirement change Publisher Copyright: Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

PY - 2018/5

Y1 - 2018/5

N2 - Objectives: As of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency in nonneonatal tracheal intubation. We hypothesized that laryngoscopy by pediatric residents has decreased over time, with a more pronounced decrease after this guideline change. Design: Prospective cohort study. Setting: Twenty-five PICUs at various children's hospitals across the United States. Patients: Tracheal intubations performed in PICUs from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children). Intervention: None. Measurements and Main Results: Prospective cohort study in which all primary tracheal intubations occurring in the United States from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children) were analyzed. Participating PICU leaders were also asked to describe their local airway management training for residents. Resident participation trends over time, stratified by presence of a Pediatric Critical Care Medicine fellowship and airway training curriculum for residents, were described. A total of 9,203 tracheal intubations from 25 PICUs were reported. Pediatric residents participated in 16% of tracheal intubations as first laryngoscopists: 14% in PICUs with a Pediatric Critical Care Medicine fellowship and 34% in PICUs without one (p < 0.001). Resident participation decreased significantly over time (3.4% per year; p < 0.001). The decrease was significant in ICUs with a Pediatric Critical Care Medicine fellowship (p < 0.001) but not in ICUs without one (p = 0.73). After adjusting for site-level clustering, patient characteristics, and Pediatric Critical Care Medicine fellowship presence, the Accreditation Council for Graduate Medical Education guideline change was not associated with lower participation by residents (odds ratio, 0.86; 95% CI, 0.59-1.24; p = 0.43). The downward trend of resident participation was similar regardless of the presence of an airway curriculum for residents. Conclusion: Laryngoscopy by pediatric residents has substantially decreased over time. This downward trend was not associated with the 2013 Accreditation Council for Graduate Medical Education change in residency requirements.

AB - Objectives: As of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency in nonneonatal tracheal intubation. We hypothesized that laryngoscopy by pediatric residents has decreased over time, with a more pronounced decrease after this guideline change. Design: Prospective cohort study. Setting: Twenty-five PICUs at various children's hospitals across the United States. Patients: Tracheal intubations performed in PICUs from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children). Intervention: None. Measurements and Main Results: Prospective cohort study in which all primary tracheal intubations occurring in the United States from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children) were analyzed. Participating PICU leaders were also asked to describe their local airway management training for residents. Resident participation trends over time, stratified by presence of a Pediatric Critical Care Medicine fellowship and airway training curriculum for residents, were described. A total of 9,203 tracheal intubations from 25 PICUs were reported. Pediatric residents participated in 16% of tracheal intubations as first laryngoscopists: 14% in PICUs with a Pediatric Critical Care Medicine fellowship and 34% in PICUs without one (p < 0.001). Resident participation decreased significantly over time (3.4% per year; p < 0.001). The decrease was significant in ICUs with a Pediatric Critical Care Medicine fellowship (p < 0.001) but not in ICUs without one (p = 0.73). After adjusting for site-level clustering, patient characteristics, and Pediatric Critical Care Medicine fellowship presence, the Accreditation Council for Graduate Medical Education guideline change was not associated with lower participation by residents (odds ratio, 0.86; 95% CI, 0.59-1.24; p = 0.43). The downward trend of resident participation was similar regardless of the presence of an airway curriculum for residents. Conclusion: Laryngoscopy by pediatric residents has substantially decreased over time. This downward trend was not associated with the 2013 Accreditation Council for Graduate Medical Education change in residency requirements.

KW - Accreditation Council for Graduate Medical Education

KW - Pediatric intensive care unit

KW - Resident

KW - Tracheal intubation

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DO - 10.1097/PCC.0000000000001470

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VL - 19

SP - E242-E250

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

IS - 5

ER -

Downward trend in pediatric resident laryngoscopy participation in PICUs

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