Abstract
Tracheal intubation (TI) guided by fibrobronchoscopy (FB) is one of the essential techniques in the approach to the difficult airway (DAW). Few works have been published on the possible causes of TI failure with this procedure. This study aims to discover which factors could predict TI failure with FB. An observational and retrospective study in which the last 122 consecutive TIs guided by FB (between January 2000 and April 2008) performed by our group were included. A multivariate analysis of the factors that could influence in the outcome was conducted: cause of the DAW, TI pathway, type of endotracheal tube, elective or urgent indication of the procedure, sedation level and experience of the bronchoscopist. Tracheal intubation in individuals who are going to undergo surgical interventions accounts for 92.6% of the total. The most frequent indications of TI by FB were: limitation of neck movement (60 cases), airway stenosis (24), increase of soft tissues (13), narrow oral aperture (9), airway compression (6), and vocal cord paralysis (6). In 10 (8.2%) cases, TI by FB was not possible. The variables that best predicted IT failure in the multivariate analysis were profound sedation/ general anesthesia (OR = 12.2; 95% CI, 1.8-84; p = 0.01) and limited experience of the bronchoscopist (OR = 25.3; 95% CI, 3.5-181.8; p = 0.001). TI guided by FB performed by bronchoscopist is successful in more than 90% of the cases with DAW. The skill and experience of the bronchoscopist is one of the primary determining factors of success of the procedure. Profound sedation may condition TI guided by FB failure.
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