With great interest, we read the article by Taboada et al.1  comparing tracheal intubation conditions in operating rooms and intensive care units. Not surprisingly, intubations in the intensive care unit were associated with worse intubation conditions and greater complications. The most frequent indication for intubation in the intensive care unit was acute respiratory failure (83%), and 63% of patients needed noninvasive ventilation before intubation.1  Intubation was by direct laryngoscopy, during apnea. The complication of hypoxia (oxygen saturation less than 80%) occurred in 19 intensive care unit patients (9%, although it was reported incorrectly in table 2 of the article as 14%). Minimizing apnea time is important for critically ill patients in respiratory failure, who might not tolerate prolonged desaturation. There are three common ways to maintain the oxygenation during intubation, including apneic oxygenation by various techniques,2  continued ventilation during intubation through a supraglottic airway guided by a flexible scope,3–5  and continued mask ventilation (fig. 1) during intubation by a flexible scope.6  We consider this method to have several advantages, including (1) apnea is almost nonexistent, and continuous ventilation increases oxygenation safety margins; (2) removing a face mask is easier than removing a supraglottic airway; (3) the technique is amenable to the nasal intubation; and (4) the method can be used with a reinforced endotracheal tube. We believe that with improved oxygenation during intubation in critically ill patients, the incidence of hypoxemia can be reduced.

Fig. 1.

Second generation endoscope and anesthesia mask (size 6). The left mask was sealed; the sealing cap was open in the center mask; and the sealing ring was taken off in the right mask. Arrow 1 indicates the nasal operating hole; double arrow 2 indicates the sealing rings; arrow 3 indicates the oral operating hole; and arrow 4 indicates the sealing cap.

Fig. 1.

Second generation endoscope and anesthesia mask (size 6). The left mask was sealed; the sealing cap was open in the center mask; and the sealing ring was taken off in the right mask. Arrow 1 indicates the nasal operating hole; double arrow 2 indicates the sealing rings; arrow 3 indicates the oral operating hole; and arrow 4 indicates the sealing cap.

Close modal

The authors declare no competing interests.

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