Abstract
Background
Airway skills such as intubation and bag-valve-mask ventilation (BVM) have historically been considered necessary skills for all general paediatricians. Recently, evidence has driven practice toward goals of reduced invasive respiratory intervention and support. While patient outcomes have improved, implications include reduced airway skill training opportunities for paediatric residents, and possibly challenges in maintaining proficiency for practicing paediatricians. From postgraduate and continuing professional educational perspectives, the specific airway skill needs for Canadian paediatricians in contemporary practice are unclear.
Objectives
Identify those airway skills that are critical to general paediatric practice in Canada, and whether the skill needs differ by patient age.
Design/Methods
Data on general paediatric procedural practice was collected in 2018 via a one-time survey through the Canadian Paediatric Surveillance Program. A database was created from the 938 collected responses. The survey asked paediatricians to indicate the frequency of performance, opinion of importance, and challenges in maintaining proficiency of various airway procedures. Data was analyzed descriptively, and questions discriminating infant (age < 2y) vs. child (age ≥ 2y) were compared by chi-square or Fisher’s exact test, as appropriate.
Results
In total, 481 (51.3%) respondents worked ≥ 50% in general paediatrics and formed the main analysis group. Responses represented broad ranges of career duration, national geography, and practice settings. BVM of infants was the most commonly performed procedure, with 196 (40.8%) performing this monthly. Infant intubation was performed monthly by 58 (12.1%). A total of 355 (73.8%) and 402 (83.6%) reported never performing laryngeal-mask airway insertion and tracheostomy tube exchange respectively. Both BVM and intubation were performed significantly more frequently in infants than in children (p < 0.001). While many respondents considered BVM and intubation of children as essential skills, significantly more rated performing these skills on infants as essential to their practice (p < 0.001). Of those paediatricians that performed procedures as part of their practice, 68/309 (22.0%) and 192/304 (63.2%) reported difficulty in maintaining proficiency in the skills of infant BVM and intubation respectively.
Conclusion
Although variably utilized, airway skills in infants and children remain a core aspect of practice for many general paediatricians. Specifically, skills related to infants were performed more frequently and were more often rated as essential. Most respondents felt it was challenging to maintain proficiency in several airway skills. Accordingly, airway skills, especially those involving infants, should be emphasized in paediatric residency programs and continuing professional development activities.