Structure and process quality illustrated by fibreoptic intubation: analysis of 1612 cases

The purpose of this investigation was the description of structure and process quality based on the analysis of 1612 fibreoptic intubations. We evaluated all fibreoptic intubations (nasotracheal in awake patients and orotracheal in anaesthetised patients) from a previously described database over a period of 2 years. We assessed structure quality by evaluating the distribution of the fibreoptic intubations across all staff anaesthetists, and process quality by analysing the number of attempts, the time required, the cases where we had to switch to conventional intubation and the complications. In all, 955 nasotracheal and 657 orotracheal intubations were evaluated. Almost all anaesthetists performed at least 15 nasotracheal and 10 orotracheal intubations. The success rate was 85.2% at the first attempt. Within 3 min, 93.9% of all fibreoptic intubations were successfully completed. In 24 cases, fibreoptic intubation was abandoned. Severe nasal bleeding as a major complication occurred in 1.3% of the nasotracheal intubations.