Hi folks,
I am fairly new to the forum, but do troll around sometimes to read critical care related posts. As a background, I am a 3rd year IM res going into Pulm CC fellowship(in about 6 days!). One specific interest of mine has been learning airway management, likely due to the significant lack of opportunities at our hospital(large academic center in north east). I always was keen to learn new procedures and pearls in the ICU. I did a few anesth electives, but 2 anesth residents come for most airways, their intern usually gets first shot at it.
My issue arises with anesthesia being called to manage all airways (except for 3 attendings who do their own). While I understand gas folks are the most experienced at managing airways, this does create a few undesirable outcomes--
1) Pulm fellows don't learn how to intubate ( do around 10-20 intubations, but 200-300 bronchs in 3 years), hence become attendings who aren't comfortable at it--> gener (we have an IP guy trained at our shop who does Perc trachs and rigid bronchs, but is uncomfortable with DL)
2) Due to the ICU team being uncomfortable with airway m/t, there is a lag time before an airway is established by anesthesia-usually 4-5 min. This approach may be sub optimal in sick people who really need plastic between their cords.
3) I believe managing airways is an essential skill required by each intensivist(even though the ACCP requires only 20 for fellowship completion), and is learned by repetition like a lot of other procedures (granted the stakes are higher)--> something that may not occur if one does not routinely manage their own.
Our program may be more stuck up because of politics and general hesitation towards any change. But I wonder what people think here wrt
Who manages airways in your ICU's(ie anesth intubating in ICU's the norm rather than the exception)
Who you believe should manage airways? (a few small head to head studies have been done b/w Anesth CC vs IM CC)
I respect all my EM, anesth, surgical colleagues a lot, so no sarcasm/turf war in the this post. Just want to know what the environment is outside my hospital.
Thanks
I am fairly new to the forum, but do troll around sometimes to read critical care related posts. As a background, I am a 3rd year IM res going into Pulm CC fellowship(in about 6 days!). One specific interest of mine has been learning airway management, likely due to the significant lack of opportunities at our hospital(large academic center in north east). I always was keen to learn new procedures and pearls in the ICU. I did a few anesth electives, but 2 anesth residents come for most airways, their intern usually gets first shot at it.
My issue arises with anesthesia being called to manage all airways (except for 3 attendings who do their own). While I understand gas folks are the most experienced at managing airways, this does create a few undesirable outcomes--
1) Pulm fellows don't learn how to intubate ( do around 10-20 intubations, but 200-300 bronchs in 3 years), hence become attendings who aren't comfortable at it--> gener (we have an IP guy trained at our shop who does Perc trachs and rigid bronchs, but is uncomfortable with DL)
2) Due to the ICU team being uncomfortable with airway m/t, there is a lag time before an airway is established by anesthesia-usually 4-5 min. This approach may be sub optimal in sick people who really need plastic between their cords.
3) I believe managing airways is an essential skill required by each intensivist(even though the ACCP requires only 20 for fellowship completion), and is learned by repetition like a lot of other procedures (granted the stakes are higher)--> something that may not occur if one does not routinely manage their own.
Our program may be more stuck up because of politics and general hesitation towards any change. But I wonder what people think here wrt
Who manages airways in your ICU's(ie anesth intubating in ICU's the norm rather than the exception)
Who you believe should manage airways? (a few small head to head studies have been done b/w Anesth CC vs IM CC)
I respect all my EM, anesth, surgical colleagues a lot, so no sarcasm/turf war in the this post. Just want to know what the environment is outside my hospital.
Thanks
