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Case Control Review of Intubation With the Flexible Fiberoptic Bronchoscope in the ICU: Safety, Complications, and Usefulness as Diagnostic Adjunct FREE TO VIEW

Ryu Tofts, MBChB; Felix Hernandez*, MD; Marlow Hernandez, DO; Amitesh Agarwal, MD; Michael Alvarez, DO; Payam Nabizadeh, MD; Huai Phen, MD; Freyer Abhi, MD; Charlene Negron, RN; Hadeh Anas, MD; Laurence Smolley, MD; Franck Rahaghi, MD; Ferrer Gustavo, MD; Ramirez Jose, MD; Oliveira Eduardo, MD
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Cleveland Clinic Florida, Weston, FL

Chest. 2012;142(4_MeetingAbstracts):395A. doi:10.1378/chest.1371747
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SESSION TYPE: Non Pulmonary Critical Care Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Fiberoptic intubation with a bronchoscope (FIB) is an accepted intubation method but there are no studies comparing the safety of routine intubation in the intensive care unit (ICU) with FIB against standard intubation with rapid sequence intubation (RSI) and a laryngoscope. We asked, is FIB safe and can it provide useful clinical information when followed with a bronchial wash (BW)?

METHODS: We conducted a retrospective case-control chart-review of all patients intubated by FIB or RSI in an 18 bed medical and surgical ICU from January 2001 to July 2009. Patients were eligible if older than 18 years, intubated on site and had adequate documentation. Demographic information was gathered; age, gender, BMI, medical history, surgery, intubation indication, sedation, and Apache II scores. We also documented vitals signs pre, immediately and 1 hour post intubation, complications, ventilator days, 30 day mortality, and whether a BW was performed and if this led to a de-escalation of antibiotics.

RESULTS: N = 348 patients were included, 248 were intubated with FIB and 100 with standard RSI. FIB and RSI groups were similar in age gender and severity of illness (mean age 68 and 66.7, male gender 61% and 64%, APACHE II scores 18.1 and 18.3, surgical patients 19% and 11%, BMI 26.4 and 26.5 in FIB and RSI groups respectively.) Indications for intubation were similar in both groups; mainly hypoxemic respiratory failure, but the RSI group was used mainly during code blues. Documented complications were 34(9.5%) FIB 9.7% vs. RSI 8.7% and were not statistically significant. Complications were mainly hypotension or de-saturations in both groups. Hemodynamic and blood gas changes were not statistically different between the groups. FIB resulted in BW in 155 patients (61%) and this led to de-escalation in antibiotics in 43 cases (27.7%: Odds ratio 8.6 95% CI 2.1 to 36.7.)

CONCLUSIONS: FIB is similar in safety and efficacy to standard RSI intubation.

CLINICAL IMPLICATIONS: FIB with BW may lead to reduced health care costs through earlier de-escalation of anti-biotics.

DISCLOSURE: The following authors have nothing to disclose: Ryu Tofts, Felix Hernandez, Marlow Hernandez, Amitesh Agarwal, Michael Alvarez, Payam Nabizadeh, Huai Phen, Freyer Abhi, Charlene Negron, Hadeh Anas, Laurence Smolley, Franck Rahaghi, Ferrer Gustavo, Ramirez Jose, Oliveira Eduardo

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Cleveland Clinic Florida, Weston, FL




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