Who does floor/ICU intubations at your hospital?

[Felodep]

Hi all,

I am currently an IM PGY 3 going into pulm cc this year. I am concerned about the amount of airway experience I have/ will get over the next 3 years. At my mid sized univ program, anesthesia does all floor and ICU airways, besides maybe 3-4 critical care attendings who do their own in the units. To get more experience, I did an anesthesia elective, and try to get as many airways in the unit with anesthesia supervising. Many pulm cc fellows I know aren't comfortable with airway m/t as well..

I was wondering who does airways in other hospitals, is this the general trend for anesth to do all airways or not? I really believe that intensivists should be comfortable with intubations, but I see many attending shy away from it, hence compromising fellow/ resident learning. I wanted to know what other medicine residents/pulm fellows feel about this.

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[rokshana]

where i trained for IM, it was anesthesia for floor as well as many icu admissions …the fellows could do it, but there wasn't always an icu fellow in house so if a code was called or a decision was made to intubate, anesthesia was called.

 

[visari]

in my program anesthesia does most of the floor intubations during codes, but if you happen to be there and want to do it they won't mind. However in real life, that rarely happens unless there's a PGY-3 going into pulm/cc in the room who wants some airway experience. In my case for example (going into hem/onc) I don't give a s*** if anesthesia does it.

Different story in the MICU, it's a closed unit and anesthesia are never there. we get to do most of the intubations there as we have priority to do them with the back up of the fellows. If it's a difficult airway we usually just back off. Usually 1st year fellows keep half of the intubations for themselves to learn as well but otherwise it's the residents doing it.

 

[FutureInternist]

Floor intubations are codes so anesthesia gets the head, surgery gets the leg & IM gives all the orders
For ICU - We were highly encouraged to ask the Anes attending (or a 2nd year or higher anes resident) to be there with us in case things went bad. The only time anes did ICU intubations was if the night anes resident happened to be a first year since they need those procedures more than an IM resident

 

[VJWDO]

We do all of our own intubations in the MICU unless we feel it is going to be difficult then we call anesthesia. But the fellows do all the airways, not the residents. If there is an intubation on the floor in a code situation then the RT's do the intubation. Our RT's are amazing and can intubate almost as good as some anesthesiologists.

 

[dozitgetchahi]

We rotate between four hospitals. At the university hospitals where there is a strong pulm/ccm fellow presence, pulm/ccm does virtually all ICU intubations and many of the floor intubations with anesthesia filling in when pulm/ccm fellows are unavailable. At the other hospitals (VA and county) the IM resident covering the ICU usually takes the first shot and anesthesia will back up.

If an intubation is urgently needed at the university hospitals, ICU is called - not anesthesia. The fellows and residents at our program do not want for airway management experience.