Wire-guided (Seldinger technique) intubation through a face mask in urgent, difficult and grossly distorted airways

Abstract

We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.

Keywords: Airway management; Treacher-collins syndrome; difficult airway; difficult intubation; fiberoptic bronchoscopy; trauma; wire-guided catheter exchange.