• Damien Roux, Jean Reignier, Guillaume Thiery, Alexandre Boyer, Jan Hayon, Bertrand Souweine, Laurent Papazian, Alain Mercat, Gilles Bernardin, Alain Combes, Jean-Daniel Chiche, Jean-Luc Diehl, Damien du Cheyron, Erwan L'her, Dominique Perrotin, Francis Schneider, Marie Thuong, Michel Wolff, Fabrice Zeni, Didier Dreyfuss, and Jean-Damien Ricard.
• 1AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France. 2UMRS-722, Univ Paris Diderot, Sorbonne Paris Cité, UMRS-722, Paris, France. 3Service de Réanimation Polyvalente, CHD Les Oudaries, La Roche sur Yon, France. 4AP-HP, Hôpital Saint-Louis, Service de Réanimation Médicale, Paris, France. 5Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, CHU Bordeaux, Bordeaux, France. 6Service de Réanimation Polyvalente, CHI Poissy-Saint-Germain en Laye, site de Saint-Germain, Saint-Germain en Laye, France. 7Service de Réanimation, CHU, Clermont Ferrand, France. 8Service de Réanimation Médicale, Hôpital Sainte Marguerite, Marseille, France. 9Service de Réanimation Médicale, CHU Angers, Angers, France. 10Service de Réanimation Médicale, CHU Nice, Nice, France. 11AP-HP, Hôpital Pitié-Salpétrière, Service de Réanimation Médicale, Paris, France. 12AP-HP, Hôpital Cochin, Service de Réanimation Médicale, Paris, France. 13AP-HP, Hôpital Européen Georges Pompidou, Service de Réanimation Médicale, Paris, France. 14Service de Réanimation Médicale, Hôpital de la Côte de Nacre, Caen, France. 15Service de Réanimation Médicale, Hôpital de la Cavale Blanche, Brest, France. 16Service de Réanimation Médicale, CHU Tours, Tours, France. 17Service de Réanimation Médicale, CHU de Strasbourg, Strasbourg, France. 18Service de Réanimation Polyvalente, Hôpital Delafontaine, Saint-Denis, France. 19AP-HP, Hôpital Bichat, Service de Réanimation Médicale, Paris, France. 20Service de Réanimation Médicale et Polyvalente Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France.
• Crit. Care Med.. 2014 Apr 1;42(4):886-95.

ObjectivesProviding appropriate training of procedural skills to residents while ensuring patient safety through trainee supervision is a difficult and constant challenge. We sought to determine how effective and safe procedural skill acquisition is in French ICUs and to identify failure and complication risk factors.DesignMulticenter prospective observational study. Invasive procedures performed by residents were recorded during two consecutive semesters.SettingEighty-four residents.SubjectsEighty-four residents.InterventionNone.Measurements And Main ResultsNumber of invasive procedures performed, failure and complication rates, supervision, and assistance provided. Five thousand six hundred seventeen procedures were prospectively studied: 1,007 tracheal intubations, 1,272 arterial and 2,586 central venous catheter insertions, 457 fiberoptic bronchoscopies, and 295 chest tube insertions. During the semesters, residents performed a median of 10 intubations, 14 arterial catheter insertions, and 26 central venous catheter insertions. Complication rates were low, similar to those in the literature: 8.6% desaturation and 7.4% esophageal placement during intubation; 0.4% and 2.3% pneumothorax with jugular and subclavian central venous catheter insertions, respectively. We identified risk factors for failure and complications. Higher rates of failure and complications for intubation were associated with residents with no or little previous experience (p < 0.001); failure of internal jugular vein catheterization was associated with left-side insertion (p = 0.005) and absence of mechanical ventilation (p = 0.007). Supervision and assistance were more frequent at the beginning of the semester and for intubation and chest tube insertion. Finally, residents had less access to fiberoptic bronchoscopy and chest tube insertion.ConclusionProcedural skills acquisition by residents in the ICU appears feasible and safe with complication rates comparable to what has previously been reported. We identified specific procedures and situations associated with higher failure and complication rates that could require proactive training. Questions still remain regarding minimal numbers of procedures to attain competence and how best to provide procedural training.

36 keywords...

hide…