Randomized comparison of experts and trainees with nasal and oral fibreoptic intubation in children less than 2 yr of age.
BACKGROUND
We hypothesized that the time to successful fibreoptic tracheal intubation through the nasal route would be faster than the oral route for both experts and trainees in children <2 yr of age.


METHODS
One hundred children, 24 months and under in age, were randomized to an operator (expert or trainee), and route (nasal or oral) for fibreoptic tracheal intubation. Three separate times were then measured: (i) time to first glottic view, (ii) time to carinal view, and (iii) total time to successful tracheal intubation. The number of attempts made, manoeuvres needed to obtain an adequate laryngeal view, and manoeuvres for tracheal tube passage were also recorded.


RESULTS
Time to successful tracheal intubation was significantly faster for experts than trainees. There was no difference in the time to tracheal intubation between the nasal and oral routes for experts. In trainees, intubation times were shorter for the nasal route-median (inter-quartile range) time (s) to carinal view was 35 (27-63) for the nasal route vs 59 (38-94) for the oral route (P=0.03), and the median time to successful tracheal intubation were 62 (49-122) vs 117 (61-224), P=0.05, for the nasal and oral routes, respectively. For trainees, the oral route required a greater number of airway manoeuvres for adequate laryngeal views and passage of the tracheal tube compared with the nasal route.


CONCLUSIONS
For clinicians with less experience in using paediatric bronchoscopes, fibreoptic tracheal intubation through the nasal route may be a more straightforward process than the oral route in children <2 yr of age.


BACKGROUND
NCT02029300 (www.clinicaltrials.gov).
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA simjag2000@yahoo.com.
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Jagannathan
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA.
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Sequera-Ramos
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA.
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Sohn
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA.
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Huang
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA.
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Sawardekar
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA.
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Wasson
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA.
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Miriyala
Feinberg School of Medicine, Northwestern University, 303 E Chicago Ave, Chicago, IL 60611, USA.
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De Oliveira
D000768:Anesthesia, General; D002983:Clinical Competence; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods*; D053208:Kaplan-Meier Estimate; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data; D009055:Mouth; D009296:Nasal Cavity
airway; children; larynx, laryngoscopy fibreoptic