title: Critical airway management: a suggested modification to the rigid fiber-optic stylet based on 301 novice intubations.
abstract: BACKGROUND
  Emergent airways in critically ill patients outside the operating room (critical airways) are often difficult airways frequently managed by intensivists. Current advanced airway management tools have not been adequately evaluated for critical airways and are not specifically designed for intensivists. The rigid fiber-optic stylet has the potential to fill this niche as it is an established difficult intubation technique very similar to bronchoscopy. The purpose of this study was to evaluate the rigid fiber-optic stylet and identify characteristics that would affect its use for critical airway management by intensivists.
  
  
  METHODS
  A retrospective, single-center, observational study was performed in the setting of a tertiary care university teaching hospital. A total of 301 consecutive elective surgery patients underwent endotracheal intubation attempted by a novice using a rigid fiber-optic stylet.
  
  
  RESULTS
  Novices could successfully intubate >95% patients using the rigid fiber-optic stylet. Most patients were intubated within 2 attempts (93%) in a median time of 73 seconds. In all the cases of intubation failure by novices, the staff anesthesiologist could successfully intubate the patient in his first attempt with an average time of 32 seconds. By studying unsuccessful attempts, we identified an important barrier to the adaptation of this tool for critical airway management-the absence of working channels, which does not allow suctioning, oxygenation, or instillation of lidocaine.
  
  
  CONCLUSIONS
  A multilumen sheath designed with 2 working channels has the potential to overcome all identified barriers to the use of rigid fiber-optic stylet as a critical airway management device by intensivists. This modification should be evaluated in a clinical study.
authors.affiliation: Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA. yashvir@ymail.com
authors.forename: Yashvir S
authors.initials: YS
authors.lastname: Sangwan
authors.forename: Jaime
authors.initials: J
authors.lastname: Palomino
authors.forename: Francesco
authors.initials: F
authors.lastname: Simeone
authors.forename: Joseph
authors.initials: J
authors.lastname: Koveleskie
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003422:Critical Care / Q000379:methods; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation / Q000379:methods; D010036:Otolaryngology / Q000592:standards*; D012189:Retrospective Studies; D013997:Time Factors