Continuous Positive-Pressure Oxygen Supply Improves Fiberoptic Intubation Efficacy and Safety in Patients With Simulated Cervical Spinal Injury: A Prospective Double-Blind Randomized Controlled Study.

Qinye, Shi; Tianlun, Zhu; Youfa, Zhou; Gang, Chen

ABSTRACT

BACKGROUND:

Fiberoptic intubation is an important method for tracheal intubation in patients with cervical spine injury. How to effectively and safely complete fiberoptic intubation while maintaining the stability of the cervical spine is very important. This study compared the efficiency and safety of fiberoptic intubation after anesthesia induction under different types of air pressure in patients with simulated cervical spinal injury.

METHODS:

In total, 59 adult patients who underwent fiberoptic intubation with a cervical collar for simulated cervical spinal injury were randomly allocated to continuous positive-pressure oxygen, normal-pressure, or intermittent negative-pressure suction groups. After the induction of anesthesia and adequate 100% oxygenation, which confirmed effective neuromuscular blockade, it was deemed appropriate to begin fiberoptic intubation. In the continuous positive-pressure oxygen group, the fiberoptic device was connected through the negative-pressure suction path with 5 L/min oxygen. In the intermittent negative-pressure suction group, the fiberoptic device was connected to the negative-pressure suction device. In the normal-pressure group, the flexible fiberoptic device was not connected to either the oxygen source or the negative-pressure suction device. The intubation time was recorded as the primary outcome measure. The intubation success rate, number of attempts, minimum SpO2, objective lens contamination rate, and incidence of complications were also compared among the groups.

RESULTS:

Compared with those in the other groups, the median (range) intubation time in the continuous positive-pressure group was 59 (36-181) seconds, which was significantly shorter than that in the normal-pressure group, 167 (46-181) seconds, and the intermittent negative-pressure suction group, 132.5 (38-181) seconds (P=0.04). The success rate of nasotracheal intubation was significantly greater in the continuous positive-pressure group (94.7%, 18/19) than in the normal-pressure group (50%, 10/20) and intermittent negative-pressure suction group (50%, 10/20) (P=0.004). There was a significant difference among the three groups (P=0.043). The median (range) minimum SpO2 during fiberoptic intubation was 100% (99-100%) in the continuous positive-pressure group, 100% (90-100%) in the normal-pressure group, and 99% (88-100%) in the intermittent negative-pressure suction group (P=0.029). However, no statistically significant difference was detected among the groups with complications.

CONCLUSION:

The continuous use of positive-pressure oxygen via the negative-pressure suction pathway can improve the efficiency and safety of fiberoptic intubation in patients with simulated cervical spinal injury after anesthesia induction.