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1001: OUTCOMES OF ICU INTUBATIONS PERFORMED BY ADVANCED PRACTICE PROVIDERS COMPARED TO PHYSICIANS

Learning Objectives: Advanced Practice Providers (APPs) routinely perform tracheal intubation in the ICU. Data on outcomes of intubations performed by APPs are limited. We compared intubations performed by APPs versus physicians to test the hypothesis that the outcomes would be similar. Methods: Patient characteristics, procedural techniques, and outcomes for intubations performed by APPs were compared to physicians using data from a multicenter randomized trial evaluating fluid loading for prevention of cardiovascular collapse during intubation of critically ill adults. Results are reported as number (%) or median (IQR). Wilcoxon-rank sum and chi-squared testing compared continuous and dichotomous variables, respectively. Results: Among 337 intubations, 14 were performed by APPs and 323 by physicians. A critical care fellow performed 79% of physician intubations, while 100% of the APP intubations were performed by an NP or PA. Baseline characteristics were similar in the APP and physician groups, including APACHE II score (22, IQR 16–30 vs 20, 15–27; p=0.54) and BMI (25 mg/kg2, IQR 22–32 vs 27 mg/kg2, 22–32; p=0.66). Hypoxemia was the most common indication for intubation in both groups (50% vs 45%, p=0.78). The proportion of patients with 1 or more predictors of difficult intubation was 29% in the APP group and 55% in the physician group (p=0.09). Median number of prior intubations performed by APPs (27, IQR 4–51) was lower than physicians (50, IQR 30– 100, p=0.01). APPs used video laryngoscopy more frequently than physicians (78% vs 33%, p<0.001). First-attempt success (85% vs.80%, p=0.61), median number of attempts (1 vs 1, p=0.57), and need for second operator (14% vs 4%, p=0.10) did not significantly differ between APPs and physicians. Incidence of cardiovascular collapse (14% vs 19%, p=.64) and severe hypoxemia (21% vs 18%, p=0.76) also did not significantly differ. Conclusions: In this secondary analysis of a recently completed randomized trial, there were no significant differences in patient characteristics or outcomes between intubations performed by APPs compared to physicians. Results are limited by small sample of APP intubations and potential bias from confounders such as differences in unmeasured baseline patient characteristics, operator experience, and procedural techniques between the two groups.