PURPOSE: Fiberoptic Intubation (FIB) is a widely accepted method of intubating a difficult airway. There are no studies assessing the safety and efficacy of FIB with a bronchoscope in the routine intubation of ICU patients.
METHODS: We conducted a retrospective chart review of 181 fiberbronchoscopic intubations in an 18 bed-unit over 4 years. Information was gathered about patient demographics, indication, sedation used, and Apache II scores. During the procedure vitals were recorded before, at 15 minutes & 1 hour afterwards, success and conversion rate, and whether a BAL or other therapeutic procedure was performed. Early and late complications were also analyzed.
RESULTS: We reviewed 181 patients requiring urgent & emergent intubations, 109 male and 72 females, with an average age 70, APACHE II score of 18 and BMI of 25. The most common indication was respiratory failure; 139 (77 %) and airway protection; 42 (23 %), 5 cases were failed rapid sequence intubation (RSI), and 5 for secretion and control of hemoptysis. There were no failed intubations or conversions to RSI. Bronchoscopy and alveolar lavage (BAL) was performed immediately on 120 (66 %), significant mucus plugging as treated in 35, diagnoses of aspiration and tumor were made in 7, and 1 had a bronchial stent placed. Sputum results from BAL resulted in a change in antibiotics in 22 cases (12 %.) The most common early complication was hypotension seen in 8 (4.4 %,) bronchospasm 1(0.6 %) and 1 difficult to place endotracheal tube. Two late complications were lidocaine induced methemaglobinuemia and mastoiditis.
CONCLUSION: Routine FIB in ICU patients as a means of intubation in non-cardiac arrest patients is safe and successful. FIB in experienced hands has few complications and allows immediate diagnostic bronchoscopy and therapeutic procedures.
CLINICAL IMPLICATIONS: Intubation with the fiberoptic bronchoscope is safe and complications are minimal. Furthermore, additional procedures and diagnostic information can be gathered aiding to diagnosis and treatment.
DISCLOSURE: Ryu Tofts, No Financial Disclosure Information; No Product/Research Disclosure Information