Comparison of fiberoptic nasotracheal intubation versus video‐assisted fiberoptic nasotracheal intubation in a difficult airway: A randomized, cross‐over, and noninferiority manikin study

Abstract Background Efficient and effective airway management is crucial in patients with difficult airways. This study compared video‐assisted fiberoptic intubation (VAFI) with conventional fiberoptic intubation (FOI) in terms of intubation time in a difficult airway manikin model. Methods A single‐center, prospective, randomized, cross‐over, and noninferiority trial was conducted. Participants were randomized to perform either FOI followed by VAFI (Group A) or VAFI followed by FOI (Group B) on a difficult airway manikin with a Cormack–Lehane IIIB view. The primary outcome was the time interval from the bronchoscope tip passing the nostril to the endotracheal tube being confirmed in the trachea. Secondary outcomes included time to visualize the vocal cords, first‐attempt success rate, and verbal rating score on ease of intubation. Results Forty‐three doctors participated in the study. The study showed significantly shorter intubation times (mean difference 64.47 s, p < 0.001) and time to visualize vocal cords (mean difference 38.00 s, p < 0.001) with VAFI compared to FOI. The first‐attempt success rate is equal for VAFI and FOI: 81.4%. VAFI with a significantly lower verbal rating score, indicating greater ease of use ( p < 0.001). Conclusion In this manikin study, VAFI demonstrated noninferiority and statistically significant superiority compared to FOI for managing difficult airways, with faster intubation times and greater ease of use. However, the study's limitations, such as the use of a manikin model and the lack of assessment of complications, should be taken into account when interpreting the results.