Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
Acad Emerg Med. 2018 Nov;25(11):1263-1267. doi: 10.1111/acem.13440. Epub 2018 May 28.
The objective was to describe the frequency, indications, and outcomes of flexible fiberoptic intubations (FFI) performed in the emergency department (ED).
From the National Emergency Airway Registry (NEAR), we identified all encounters from July 1, 2002, through December 31, 2012, with the use of FFI. We determined patient, provider, and intubation characteristics; success and failure rates; and modes of intubation rescue.
Among 17,910 intubations of patients > 15 years old at 13 EDs, FFI was used in 204 cases (1.1%, 95% confidence interval [CI] = 0.26%-2.0%). FFI was the first method chosen (primary FFI) in 180 encounters (1%, 95% CI = 0.2%-1.8%). The most common indication for FFI was airway obstruction (36.1%, 95% CI = 24.6%-47.7%). For primary FFI, first-attempt intubation success was 51.1% (95% CI = 43.6%-58.6%), and overall intubation success with FFI was 74.3% (95% CI = 65.7%-82.9%). FFI was used as a rescue airway strategy in 24 cases (0.1% of all encounters) and was successful in 17 of those (70.8%, 95% CI = 65.4%-85.2%).
Emergency department FFI is uncommon and typically used as a nonsurgical alternative for airway obstruction. First-attempt ED FFI is successful in half of cases and in two-thirds of rescue attempts. These data provide an important baseline to help better characterize the nature of FFI as a rare critical procedure in the ED and offer an empiric basis for ongoing discussions on the optimal role of FFI in ED training and practice.
描述急诊部（ED）中进行的软性纤维支气管镜插管（FFI）的频率、适应证和结果。
我们从国家紧急气道登记处（NEAR）中确定了 2002 年 7 月 1 日至 2012 年 12 月 31 日期间所有使用 FFI 的病例。我们确定了患者、提供者和插管的特征；成功率和失败率；以及插管抢救的方式。
在 13 个 ED 中，对年龄大于 15 岁的 17910 例患者进行了插管，其中 204 例（1.1%，95%置信区间[CI]为 0.26%-2.0%）使用了 FFI。FFI 是 180 例（1%，95%CI为 0.2%-1.8%）中首选的方法（主要 FFI）。FFI 最常见的适应证是气道阻塞（36.1%，95%CI为 24.6%-47.7%）。对于主要 FFI，首次尝试插管成功率为 51.1%（95%CI为 43.6%-58.6%），FFI 总插管成功率为 74.3%（95%CI为 65.7%-82.9%）。FFI 作为一种抢救气道策略在 24 例（所有病例的 0.1%）中使用，其中 17 例（70.8%，95%CI为 65.4%-85.2%）成功。
ED 中的 FFI 并不常见，通常作为气道阻塞的非手术替代方法。ED 中首次尝试 FFI 的成功率为一半，在抢救尝试中成功率为三分之二。这些数据提供了一个重要的基线，有助于更好地描述 FFI 作为 ED 中一种罕见的关键程序的性质，并为正在进行的关于 FFI 在 ED 培训和实践中的最佳作用的讨论提供了经验基础。
