Barotrauma: a life‐threatening complication of fiberoptic endotracheal intubation in a neonate

Khan, Rashid M.; Sharma, Pradeep; Kaul, Naresh

doi:10.1111/j.1460-9592.2010.03360.x

Cited by 12 publications

(12 citation statements)

References 5 publications

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“…However, a few reports have documented rare but critical complications such as gastric rupture and pneumothorax [ 10 – 12 ]. Moreover, this technique is not recommended for pediatric patients or patients with significant airway edema [ 11 ]. Thus, oxygen insufflation through the working channel during FOB intubation has certain advantages and limitations.…”

Section: Introductionmentioning

confidence: 99%

Utility of oxygen insufflation through working channel during fiberoptic intubation in apneic patients: a prospective randomized controlled study

et al. 2020

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Background Airway management is a part of routine anesthetic procedures; however, serious complications, including hypoxia and death, are known to occur in cases of difficult airways. Therefore, alternative techniques such as fiberoptic bronchoscope-assisted intubation (FOB intubation) should be considered, although this method requires more time and offers a limited visual field than does intubation with a direct laryngoscope. Oxygen insufflation through the working channel during FOB intubation could minimize the risk of desaturation and improve the visual field. Therefore, the aim of this prospective randomized controlled study was to evaluate the utility and safety of oxygen insufflation through the working channel during FOB intubation in apneic patients. Methods Thirty-six patients were randomly allocated to an N group (no oxygen insufflation) or an O group (oxygen insufflation). After preoxygenation, FOB intubation was performed with (O group) or without (N group) oxygen insufflation in apneic patients. The primary outcome was the velocity of decrease in the partial pressure of oxygen (PaO2) during FOB intubation (VPaO2, mmHg/sec) defined as the difference of PaO2 before and after intubation divided by the time to intubation. The secondary outcomes included the success rate for FOB intubation, time to intubation, visual field during FOB intubation, findings of arterial blood gas analysis, and occurrence of FOB intubation-related complications. Results We found that VPaO2 was significantly greater in the N group than in the O group (1.0 ± 0.4 vs. 0.4 ± 0.4; p < 0.001), while the visual field was similar between groups. There were no significant intergroup differences in the secondary outcomes. Conclusions These findings suggest that oxygen insufflation through the working channel during FOB intubation aids in extending the apneic window during the procedure. Trial registration ClinicalTrials.gov, NCT02625194, registered at December 9, 2015.

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Section: Introductionmentioning

confidence: 99%

Utility of oxygen insufflation through working channel during fiberoptic intubation in apneic patients: a prospective randomized controlled study

et al. 2020

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“…Oxygen insu ation through the working channel of FOB can cause rare but serious complications such as gastric rupture and pneumothorax. (10,11,27) Oxygen can enter the trachea or esophagus during the procedure. If oxygen is delivered to the esophagus and stomach, it could cause nausea, vomiting.…”

Section: Discussionmentioning

confidence: 99%

“…(5,9) However, a few reports have documented rare but critical complications such as gastric rupture and pneumothorax. (10)(11)(12) Moreover, this technique is not recommended for pediatric patients or patients with signi cant airway edema. (11) Thus, oxygen insu ation through the working channel during FOB intubation has certain advantages and limitations.…”

Section: Introductionmentioning

confidence: 99%

Utility of oxygen insufflation through working channel during fiberoptic intubation in apneic patients: a prospective randomized controlled study

Roh

Kang

Han

et al. 2020

Preprint

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Background: Airway management is a part of routine anesthetic procedures; however, serious complications, including hypoxia and death, are known to occur in cases of difficult airways. Therefore, alternative techniques such as fiberoptic bronchoscope-assisted intubation (FOB intubation) should be considered, although this method requires more time and offers a limited visual field than does intubation with a direct laryngoscope. Oxygen insufflation through the working channel during FOB intubation could minimize the risk of desaturation and improve the visual field. Therefore, the aim of this prospective randomized controlled study was to evaluate the utility and safety of oxygen insufflation through the working channel during FOB intubation in apneic patients. Methods: Thirty-six patients were randomly allocated to an N group (no oxygen insufflation) or an O group (oxygen insufflation). After preoxygenation, FOB intubation was performed with (O group) or without (N group) oxygen insufflation in apneic patients. The primary outcome was the velocity of decrease in the partial pressure of oxygen (PaO2) during FOB intubation (VPaO2, mmHg/sec) defined as the difference of PaO2 before and after intubation divided by the time to intubation. The secondary outcomes included the success rate for FOB intubation, time to intubation, visual field during FOB intubation, findings of arterial blood gas analysis, and occurrence of FOB intubation-related complications. Results: We found that VPaO2 was significantly greater in the N group than in the O group (1.0 ± 0.4 vs. 0.4 ± 0.4; p < 0.001), while the visual field was similar between groups. There were no significant intergroup differences in the secondary outcomes. Conclusions: These findings suggest that oxygen insufflation through the working channel during FOB intubation aids in extending the apneic window during the procedure.Trial registration: ClinicalTrials.gov, NCT02625194, registered at December 9, 2015

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“…Barotrauma can occur when oxygen is insufflated under pressure into the respiratory tract, notably when the egress of insufflated gas volume is less than the volume of inspired gas. Case reports describe such occurrence during flexible bronchoscopy through an ETT in infants, and it is recommended to avoid using the working channel for insufflating oxygen . The literature does suggest that carefully controlled oxygen insufflation via the bronchoscope in the tracheal position in infants appears safe without the presence of an ETT .…”

Section: Discussionmentioning

confidence: 99%

Tension pneumothorax during flexible bronchoscopy in a nonintubated infant

Chan

Gamble

2016

Pediatric Anesthesia

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Barotrauma: a life‐threatening complication of fiberoptic endotracheal intubation in a neonate

Cited by 12 publications

References 5 publications

Utility of oxygen insufflation through working channel during fiberoptic intubation in apneic patients: a prospective randomized controlled study

Utility of oxygen insufflation through working channel during fiberoptic intubation in apneic patients: a prospective randomized controlled study

Utility of oxygen insufflation through working channel during fiberoptic intubation in apneic patients: a prospective randomized controlled study

Tension pneumothorax during flexible bronchoscopy in a nonintubated infant

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