Tracheal intubation to a hypoxic patient is challenging because of the risk of worsening oxygenation during the intubation procedure. We previously reported the tracheal tube could be used as a nasally inserted supraglottic airway. This use can prevent hypoxia during the intubation procedure in a patient with known respiratory distress. A male patient breathing with non-invasive positive ventilation had vomiting and a massive aspiration. Immediate bag-valve-mask ventilation did not improve oxygenation, and emergent intubation was planned. We adopted nasal fiberoptic intubation with intermittent ventilation during the advancement of the tracheal tube. When SpO2 worsened, the procedure was suspended, and the patient was ventilated via the nasally placed tracheal tube with the closure of the mouth and the other nostril. Intubation was completed without worsening of hypoxia. During the intubation procedure, the worsening of hypoxia may occur in airway management for patients with respiratory distress. The nasal route of intubation enables intermittent ventilation and guarantee oxygenation during the procedure. This procedure can be applied to patients with respiratory distress to avert hypoxia during the intubation procedure.

Tracheal intubation to a hypoxic patient is challenging because of the risk of worsening oxygenation during the intubation procedure. When muscle relaxant is used for intubation, patient becomes apneic during intubation procedure that may lead hypoxia [1,2]. If you choose awake oral intubation, patients can breathe spontaneously, however, positive pressure ventilation or pressure support cannot be applied during the procedure [3]. We previously reported the tracheal tube can be used as a nasally inserted supraglottic airway [4]. Here we report this use can prevent hypoxia during the intubation procedure in a patient with known respiratory distress.

A male patient breathing with non-invasive positive ventilation had vomiting and a massive aspiration in the intensive care unit. Immediate bag-valve-mask ventilation with 100% oxygen did not improve oxygenation, and emergent intubation was planned. We anticipated worsening of hypoxia during laryngoscopy especially with use of muscle relaxant. We adopted nasal fiberoptic intubation with intermittent ventilation via the tracheal tube used as a supraglottic airway during the advancement of the tracheal tube. When SpO2 worsened, the fiberscope was pulled out, and the patient was ventilated using the Jackson-Rees circuit with the tight closure of the mouth and the other nostril. Intubation was completed without worsening of hypoxia.

In the ICU and the emergency department, physicians often encounter patients with severe respiratory distress; however, there is no established intubation protocol for these patients. During the intubation procedure, the worsening of hypoxia is a great concern in airway management for patients with respiratory distress. The nasal route of intubation enables intermittent ventilation and guarantee oxygenation during the procedure. This procedure can be applied to patients with respiratory distress to avert hypoxia during the intubation procedure. The doble role of tracheal tube prevent hypoxia in those patients.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

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