DOES NASOTRACHEAL INTUBATION INCREASE COMPLICATIONS IN PATIENTS WITH SKULL BASE FRACTURES

Study objectives: To determine if the complications associated with sk ull base fractures are increased when nasotracheal intubation is perfo rmed in the field. Design: Retrospective, case-control study over a fi ve-year period. Setting: A helicopter service returning to a Level I t rauma center. Type of participants: All injured patients treated in th e field who had either radiographic or clinical evidence of skull base fractures in whom nasotracheal intubation was attempted (38) compared with all patients with skull base fractures in whom nasotracheal intu bation was not attempted (48) and a convenience sample of patients wit hout skull base fractures in whom nasotracheal intubation was attempte d (45). Patients with obvious midface motion on initial examination we re excluded. Complications of skull base fractures were categorized as cerebral spinal fluid leak of longer than 24 hours and/or meningitis, cranial nerve injury, diabetes insipidus, and intracranial placement of the endotracheal tube. Interventions: Blind nasotracheal intubation was performed by experienced flight nurses. Results: There were no pa tients in whom an endotracheal tube was placed intracranially. There w as no significant difference in complication rate between the two grou ps with skull base fractures (with nasotracheal intubation, 24%; 95% c onfidence interval, 11% to 40%, without nasotracheal intubation, 25%; 95% confidence interval, 14% to 40%). The group without skull base fra cture had none of the complications usually associated with skull base fractures. Conclusion: Patients with skull base fracture have a signi ficant complication rate (25%). The complications associated with skul l base fractures are not markedly increased by attempts at nasotrachea l intubation in the field.