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

The aim of this study was to compare fiberoptic-guided airway exchange of t he esophageal-tracheal Combitube(R) (ETC, Kendall-Sheridan Catheter Corp., Argyle, NY) with an endotracheal tube in spontaneously breathing versus mec hanically 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, mechanic ally ventilated patients. After anesthetic induction and insertion of the E TC, a fiberoptic bronchoscope threaded into an armored endotracheal tube wa s passed transnasally into the larynx. Endotracheal intubation was successf ul in 18 spontaneously breathing patients and in 15 patients during control led 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 meth ods allowed for continuous airway control and maintenance of ventilation an d oxygenation. The described method is a means of replacing the ETC with an endotracheal tube without interruption of airway control or ventilation. R eplacing the ETC with an endotracheal tube using this method is more readil y accomplished during spontaneous ventilation than;luring controlled ventil ation. Implications: We describe the replacement of the Combitube(R) by an endotracheal tube by the aid of fiberoptic bronchoscopy and without interru ption of airway control or ventilation. The performance of this technique w as facilitated by spontaneous ventilation compared with mechanical ventilat ion.