• Aayush Gabrani, Taiki Kojima, Ronald C Sanders, Asha Shenoi, Vicki Montgomery, Simon J Parsons, Sandeep Gangadharan, Sholeen Nett, Natalie Napolitano, Keiko Tarquinio, Dennis W Simon, Anthony Lee, Guillaume Emeriaud, Michelle Adu-Darko, John S Giuliano, Keith Meyer, Ana Lia Graciano, David A Turner, Conrad Krawiec, Adnan M Bakar, Lee A Polikoff, Margaret Parker, Ilana Harwayne-Gidansky, Benjamin Crulli, Paula Vanderford, Ryan K Breuer, Eleanor Gradidge, Aline Branca, Lily B Grater-Welt, David Tellez, Lisa V Wright, Matthew Pinto, Vinay Nadkarni, Akira Nishisaki, and National Emergency Airway Registry for Children (NEAR4KIDS) Collaborators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI).
• Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, Philadelphia, PA.
• Pediatr Crit Care Me. 2018 May 1; 19 (5): e242-e250.

ObjectivesAs of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency in nonneonatal tracheal intubation. We hypothesized that laryngoscopy by pediatric residents has decreased over time, with a more pronounced decrease after this guideline change.DesignProspective cohort study.SettingTwenty-five PICUs at various children's hospitals across the United States.PatientsTracheal intubations performed in PICUs from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children).InterventionNone.Measurements And Main ResultsProspective cohort study in which all primary tracheal intubations occurring in the United States from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children) were analyzed. Participating PICU leaders were also asked to describe their local airway management training for residents. Resident participation trends over time, stratified by presence of a Pediatric Critical Care Medicine fellowship and airway training curriculum for residents, were described. A total of 9,203 tracheal intubations from 25 PICUs were reported. Pediatric residents participated in 16% of tracheal intubations as first laryngoscopists: 14% in PICUs with a Pediatric Critical Care Medicine fellowship and 34% in PICUs without one (p < 0.001). Resident participation decreased significantly over time (3.4% per year; p < 0.001). The decrease was significant in ICUs with a Pediatric Critical Care Medicine fellowship (p < 0.001) but not in ICUs without one (p = 0.73). After adjusting for site-level clustering, patient characteristics, and Pediatric Critical Care Medicine fellowship presence, the Accreditation Council for Graduate Medical Education guideline change was not associated with lower participation by residents (odds ratio, 0.86; 95% CI, 0.59-1.24; p = 0.43). The downward trend of resident participation was similar regardless of the presence of an airway curriculum for residents.ConclusionLaryngoscopy by pediatric residents has substantially decreased over time. This downward trend was not associated with the 2013 Accreditation Council for Graduate Medical Education change in residency requirements.

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