Fiberoptic intubation in the emergency department: a case series

A prospective descriptive study was conducted to evaluate the feasibility of using fiberoptic bronchoscopy to replace blind nasotracheal intubation. The study was performed from November 1989 to August 1991 at a university teaching tertiary care hospital. Intubations were performed by three senior emergency physicians with no prior clinical experience in emergency fiberoptic intubation. Training in fiberoptic intubation was carried out on anesthetized patients, intubation manikins, and cadavers. All patients coming to the emergency department who would have been intubated in the blind nasotracheal manner were eligible for fiberoptic intubation, except for apneic patients and those intubated by residents learning other techniques. An independent observer collected the data. Forty-two patients were entered into the study, 22 males and 20 females, with an average age of 64 years. The success rate was 72% (30/42), with one of the investigators performing most of the intubations (22, 52%). His success rate was 82%. The other two investigators' success rates were 64% and 56%. Most failures were ascribed to coping with secretions. In conclusion, intubation with the fiberoptic bronchoscope can be a useful alternative to blind nasotracheal intubation. Success with this technique is dependent on the airway being free of secretions and blood.