title: Bronchoscopic intubation is an effective airway strategy in critically ill patients.
abstract: American Society of Anesthesiologists guidelines recommend the use of bronchoscopic intubation as a rescue technique in critically ill patients. We sought to assess the safety and efficacy of bronchoscopic intubation as an initial approach in critically ill patients.
  
  
  
  We performed a retrospective cohort study of patients who underwent endotracheal intubation in the medical intensive care unit of a tertiary urban referral center over 1 academic year. The primary outcome was first-pass success rate.
  
  
  
  We identified 219 patients who underwent either bronchoscopic (n=52) or laryngoscopic guided (n=167) intubation as the initial attempt. There was a higher first-pass success rate in the bronchoscopic intubation group than in the laryngoscopic group (96% vs 78%; P=.003). The bronchoscopic intubation group had a higher body mass index (28.4 vs 25.9; P=.027) and higher preintubation fraction of inspired oxygen requirement (0.73±0.27 vs 0.63±0.30; P=.044) than the laryngoscopic group. There were no cases of right mainstem intubation, esophageal intubation, or pneumothorax with bronchoscopic intubation. Rates of postintubation hypotension and hypoxemia were similar in both groups. The association with first-pass success remained with multivariate and propensity matched analysis.
  
  
  
  Bronchoscopic intubation as an initial strategy in critically ill patients is associated with a higher first-pass success rate than laryngoscopic intubation, and is not associated with an increase in complications.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ma
authors.affiliation: Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine UCLA, Los Angeles.
authors.forename: Augustine
authors.initials: A
authors.lastname: Chung
authors.affiliation: Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York.
authors.forename: Kerri I
authors.initials: KI
authors.lastname: Aronson
authors.affiliation: Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York.
authors.forename: Jamuna K
authors.initials: JK
authors.lastname: Krishnan
authors.affiliation: Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine UCLA, Los Angeles.
authors.forename: Igor Z
authors.initials: IZ
authors.lastname: Barjaktarevic
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York.
authors.forename: David A
authors.initials: DA
authors.lastname: Berlin
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York. Electronic address: ejs9005@med.cornell.edu.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Schenck
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007828:Laryngoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009518:New York; D061214:Patient Safety; D012189:Retrospective Studies
keywords: Bronchoscopy; Critical care; Endotracheal intubation; Outcomes