title: Nasotracheal intubation in the emergency department, revisited.
abstract: This retrospective study was designed to investigate the current practice of nasotracheal intubation (NTI) in the Emergency Department (ED) at the University of California, San Diego Medical Center. Over a 5-year period, 21% (105/501) of patients intubated in the ED had at least one NTI attempt. The most frequent primary diagnoses in these patients included drug overdose, congestive heart failure, and chronic obstructive pulmonary disease. We report an overall NTI success rate of 79% (83/105). Sixty-one percent (64/105) of the patients were nasally intubated on the first NTI attempt. Nasal dilators, topical neosynephrine, and sedation improved NTI success rates. Epistaxis and improper tube position were the most common immediate complications. Sinusitis, pneumonia, and sepsis were the most frequent late complications. Patients receiving thrombolytic therapy were at risk of developing severe epistaxis. A prior history of sinus disease may predispose a nasally intubated patient to sinusitis. The complication rates reported here are similar to those of previous studies. A survey of emergency medicine (EM) residency programs found that EM residents throughout the country perform an average of 2.8 NTIs during their residency training. Thus, there is limited exposure to this intubation technique in EM residency programs. Nasotracheal intubation is a useful alternative to oral intubation, particularly when oral access is compromised. While not the optimal approach, we conclude that NTI is still a valuable method for establishing an airway and should remain among the emergency physician's arsenal of intubation techniques.
authors.affiliation: Department of Emergency Medicine, University of California, San Diego Medical Center, 92103-8676, USA.
authors.forename: L P
authors.initials: LP
authors.lastname: Roppolo
authors.forename: G M
authors.initials: GM
authors.lastname: Vilke
authors.forename: T C
authors.initials: TC
authors.lastname: Chan
authors.forename: S
authors.initials: S
authors.lastname: Krishel
authors.forename: S R
authors.initials: SR
authors.lastname: Hayden
authors.forename: P
authors.initials: P
authors.lastname: Rosen
authors.forename: M
authors.initials: M
authors.lastname: Trione
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D004635:Emergency Medicine / Q000193:education; D004638:Emergency Treatment; D004844:Epistaxis / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006753:Hospital Records; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008173:Lung Diseases, Obstructive / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000628:therapy; D012189:Retrospective Studies