Is Nasotracheal Intubation Safe in Facial Trauma Patients?

Omeed P. Jazayeri-Moghaddas; Wayne Tse; Karen Herzing; Ronald J. Markert; Alyssa J. Gans; Mary C. McCarthy

doi:10.1016/j.amjsurg.2016.11.003

Is Nasotracheal Intubation Safe in Facial Trauma Patients?

Omeed P. Jazayeri-Moghaddas, Wayne Tse, Karen Herzing, Ronald J. Markert, Alyssa J. Gans, Mary C. McCarthy

Research output: Contribution to journal › Article › peer-review

Abstract

<p> <h3 id="x-x-sectitle0015"> Background </h3> <p id="x-x-abspara0010"> In the prehospital setting, oral intubation is preferred in facial trauma patients due to the potential for further injury during nasotracheal intubation. This study compared the complications of nasal vs. oral vs. nasal + oral intubations performed by first responder crews in facial trauma patients. Our objective was to assess patient outcomes and complications to determine the risk of nasal intubation in facial trauma patients in the prehospital setting. <h3 id="x-x-sectitle0020"> Methods </h3> <p id="x-x-abspara0015"> Patients with facial trauma between 2008 and 13 were abstracted from the Miami Valley Hospital trauma registry: 50 were <em> nasal only </em> (n), 27 <em> nasal </em> + <em> oral (no) </em> , and 135 <em> oral only (o) </em> intubation. Analysis of variance with the post-hoc Least Significance Difference Test and the chi square test were used in the analysis. <h3 id="x-x-sectitle0025"> Results </h3> <p id="x-x-abspara0020"> The oral group was older [41.1 ± 17.6 (o) vs. 36.2 ± 14.1 (n) vs. 33.0 ± 15.7 (no), p = 0.032] and had a higher facial abbreviated injury severity (AIS) mean score (1.8 ± 0.6 vs. 1.3 ± 0.5 vs. 1.5 ± 0.5, p < 0.001). The three groups did not differ in mortality (n = 20% vs. o = 18% vs. no = 30%, p = 0.37). The n + o group was intubated longer (p < 0.001) and had longer ICU and hospital lengths of stay (p = 0.015 and p = 0.023). The three groups did not differ on the composite of any pulmonary complication – i.e., any one of sinusitis, pneumonia, atelectasis, and respiratory failure - 44% (no) vs. 24% (o) vs. 30% (n), p = 0.10). However, <em> nasal </em> + <em> oral </em> patients were more likely to have one or more of the eight complication studied [63% (no) vs. 28% (o) vs. 34% (n), p = 0.002], and have a longer ICU and HLOS. <h3 id="x-x-sectitle0030"> Conclusions </h3> <p id="x-x-abspara0025"> Prehospital <em> nasal </em> intubation is a viable short-term alternative to <em> oral </em> intubation in patients with facial trauma and warrants further research. </p> </p> </p> </p></p>

Original language	American English
Journal	American Journal of Surgery
Volume	213
DOIs	https://doi.org/10.1016/j.amjsurg.2016.11.003
State	Published - Mar 1 2017

Keywords

Nasal intubation
Facial trauma
First responders

Disciplines

Medical Specialties
Medicine and Health Sciences
Surgery

Access to Document

10.1016/j.amjsurg.2016.11.003License: CC BY

Cite this

@article{e5e2b244168f454f8e3cd661ea36edb1,

title = "Is Nasotracheal Intubation Safe in Facial Trauma Patients?",

abstract = " Background In the prehospital setting, oral intubation is preferred in facial trauma patients due to the potential for further injury during nasotracheal intubation. This study compared the complications of nasal vs. oral vs. nasal + oral intubations performed by first responder crews in facial trauma patients. Our objective was to assess patient outcomes and complications to determine the risk of nasal intubation in facial trauma patients in the prehospital setting. Methods Patients with facial trauma between 2008 and 13 were abstracted from the Miami Valley Hospital trauma registry: 50 were nasal only (n), 27 nasal + oral (no) , and 135 oral only (o) intubation. Analysis of variance with the post-hoc Least Significance Difference Test and the chi square test were used in the analysis. Results The oral group was older [41.1 ± 17.6 (o) vs. 36.2 ± 14.1 (n) vs. 33.0 ± 15.7 (no), p = 0.032] and had a higher facial abbreviated injury severity (AIS) mean score (1.8 ± 0.6 vs. 1.3 ± 0.5 vs. 1.5 ± 0.5, p < 0.001). The three groups did not differ in mortality (n = 20% vs. o = 18% vs. no = 30%, p = 0.37). The n + o group was intubated longer (p < 0.001) and had longer ICU and hospital lengths of stay (p = 0.015 and p = 0.023). The three groups did not differ on the composite of any pulmonary complication – i.e., any one of sinusitis, pneumonia, atelectasis, and respiratory failure - 44% (no) vs. 24% (o) vs. 30% (n), p = 0.10). However, nasal + oral patients were more likely to have one or more of the eight complication studied [63% (no) vs. 28% (o) vs. 34% (n), p = 0.002], and have a longer ICU and HLOS. Conclusions Prehospital nasal intubation is a viable short-term alternative to oral intubation in patients with facial trauma and warrants further research. ",

keywords = "Nasal intubation, Facial trauma, First responders",

author = "Jazayeri-Moghaddas, {Omeed P.} and Wayne Tse and Karen Herzing and Markert, {Ronald J.} and Gans, {Alyssa J.} and McCarthy, {Mary C.}",

year = "2017",

month = mar,

day = "1",

doi = "10.1016/j.amjsurg.2016.11.003",

language = "American English",