From Two Steps to One: Re-engineering Flexible Bronchoscope-guided Tracheal Intubation

Flexible bronchoscope-guided tracheal intubation is still seen as the gold standard for management of the anticipated difficult airway. However, as a sophisticated technique, it is underused even in situations with a clear indication. The main reasons are a lack of expertise and fear of the patient’s nonacceptance. Both could have dramatic consequences. Simplification of the technique might lower the inhibition threshold for usage in situations with a clear indication. We therefore propose a one-step flexible bronchoscope-guided intubation using a re-engineered tube that has the potential to reduce the failure rate with this technique and decrease patients’ discomfort during awake intubation. The remaining challenge is to produce a prototype for an expandable tube that subsequently fulfills the requirements regarding size, stability, and compatibility. From a patient safety point of view, further exploration of this topic is worthwhile.