Structured Debriefing After Adult ICU Intubation: A Narrative Review and Implementation Framework.

BACKGROUND: Endotracheal intubation in the intensive care unit (ICU) carries substantial risk, with adverse events such as hypoxia and hemodynamic instability occurring in up to 40% of critically ill patients. These events affect not only patient safety but also team learning and trainee development. Structured debriefing, defined as brief, reflective discussion following a critical event, represents a potential strategy to mitigate risks and strengthen team performance in high acuity environments. OBJECTIVE: To synthesize theoretical and empirical literature on structured debriefing after ICU intubation and identify barriers and facilitators to implementation. We propose an adult ICU-focused, pragmatic framework that uses brief post-intubation hot debriefing with selective escalation to cold debriefing, linking airway events to measurable learning and safety processes. METHODS: We conducted a narrative review informed by a comprehensive search of PubMed, Scopus, Ovid MEDLINE, and Google Scholar (1999-2026). Eligible sources included peer-reviewed studies and high-quality reviews addressing debriefing in acute and critical care contexts, evaluation of debriefing tools, and theoretical frameworks related to psychological safety and team learning. Simulation-only studies were excluded unless they informed clinical translation or implementation-relevant debriefing frameworks. RESULTS: Evidence from perioperative, trauma, and emergency medicine demonstrates that structured debriefing is feasible, valued, and effective in surfacing latent safety threats, enhancing communication, and promoting psychological safety. Early ICU applications confirm feasibility but expose barriers, including competing clinical demands, hierarchical culture, and varied faculty training. Adaptations, such as embedding debriefing into airway safety bundles, training fellows to lead discussions, and incorporating digital or hybrid approaches show promise. However, most studies focus on feasibility and perceptions rather than patient-level (or team-level) outcomes. CONCLUSION: This review proposes a pragmatic, adult ICU-focused framework that translates existing debriefing tools into a testable model for improving team learning, psychological safety, and system-level safety processes following adult ICU intubation.