Fiberoptic-guided airway exchange of the esophageal-tracheal Combitube® in spontaneously breathing versus mechanically ventilated patients

The aim of this study was to compare fiberoptic-guided airway exchange of the esophageal-tracheal Combitube(R) (ETC, Kendall-Sheridan Catheter Corp., Argyle, NY) with an endotracheal tube in spontaneously breathing versus mechanically ventilated patients. Forty patients with Mallampati score III and TV scheduled for elective surgery were randomly allocated into two groups (n = 20 each): nonparalyzed, spontaneously breathing or paralyzed, mechanically ventilated patients. After anesthetic induction and insertion of the ETC, a fiberoptic bronchoscope threaded into an armored endotracheal tube was passed transnasally into the larynx. Endotracheal intubation was successful in 18 spontaneously breathing patients and in 15 patients during controlled ventilation. Successful airway exchange was completed in significantly less time (P < 0.05) in spontaneously breathing patients (9 +/- 3 min; mean +/- so) than in mechanically ventilated patients (13 +/- 4 min). Both methods allowed for continuous airway control and maintenance of ventilation and oxygenation. The described method is a means of replacing the ETC with an endotracheal tube without interruption of airway control or ventilation. Replacing the ETC with an endotracheal tube using this method is more readily accomplished during spontaneous ventilation than;luring controlled ventilation. Implications: We describe the replacement of the Combitube(R) by an endotracheal tube by the aid of fiberoptic bronchoscopy and without interruption of airway control or ventilation. The performance of this technique was facilitated by spontaneous ventilation compared with mechanical ventilation.