Awake Bedside Intubation of an Infant Using a Single-Use Flexible Bronchoscope: A Case-Based Technical Report

Area of Science:

• Pediatric Otolaryngology
• Pediatric Critical Care
• Airway Management

Background:

• Flexible bronchoscopic intubation is an option for difficult pediatric airways.
• Its use in sedated or small infants without a supraglottic conduit is not well-described.
• Infants with trisomy 13, cleft lip/palate, and respiratory distress pose unique airway challenges.

Purpose of the Study:

• To describe the feasibility of awake bedside intubation in a small infant with a complex airway.
• To evaluate the use of an ultrathin bronchoscope without sedation or supraglottic conduit.
• To highlight the importance of careful tube depth monitoring.

Main Methods:

• Report of a case involving a 6-week-old infant (3.1 kg) with trisomy 13, cleft lip/palate, and respiratory distress.
• Awake direct oral intubation performed in the ICU using a single-use ultrathin bronchoscope (Ambu aScope 5 Broncho) preloaded with a 3.5-mm cuffed endotracheal tube.
• Spontaneous ventilation maintained; no sedation, supraglottic airway, or videolaryngoscopy used.

Main Results:

• Successful first-attempt tracheal intubation confirmed by capnography.
• Transient right mainstem intubation required tube withdrawal.
• Flexible tracheobronchoscopy revealed tracheomalacia and bilateral bloody secretions.

Conclusions:

• Awake bedside direct oral intubation with an ultrathin bronchoscope is feasible in small infants with complex craniofacial anatomy and anticipated difficult airways.
• This technique preserves spontaneous ventilation.
• Meticulous monitoring of endotracheal tube depth is crucial to prevent endobronchial intubation.