Does nasotracheal intubation increase complications in patients with skull base fractures?

To determine if the complications associated with skull base fractures are increased when nasotracheal intubation is performed in the field.

Retrospective, case-control study over a five-year period.

A helicopter service returning to a Level I trauma center.

All injured patients treated in the field who had either radiographic or clinical evidence of skull base fractures in whom nasotracheal intubation was attempted (38) compared with all patients with skull base fractures in whom nasotracheal intubation was not attempted (48) and a convenience sample of patients without skull base fractures in whom nasotracheal intubation was attempted (45). Patients with obvious midface motion on initial examination were excluded. Complications of skull base fractures were categorized as cerebral spinal fluid leak of longer than 24 hours and/or meningitis, cranial nerve injury, diabetes insipidus, and intracranial placement of the endotracheal tube.

Blind nasotracheal intubation was performed by experienced flight nurses.

There were no patients in whom an endotracheal tube was placed intracranially. There was no significant difference in complication rate between the two groups with skull base fractures (with nasotracheal intubation, 24%; 95% confidence interval, 11% to 40%; without nasotracheal intubation, 25%; 95% confidence interval, 14% to 40%). The group without skull base fracture had none of the complications usually associated with skull base fractures.

Patients with skull base fracture have a significant complication rate (25%). The complications associated with skull base fractures are not markedly increased by attempts at nasotracheal intubation in the field.