Facilitation of fiberoptic nasotracheal intubation in a morbidly obese patient by simultaneous use of nasal CPAP.

A morbidly obese patient was emergently nasotracheally intubated using a fiberoptic bronchoscope. Simultaneous application of 20 cm H2O nasal continuous positive airway pressure (CPAP) to the contralateral naris using a nasal pillow helped maintain ventilation of the patient during intubation and greatly facilitated visualization of anatomic landmarks and translaryngeal passage of the bronchoscope. Fiberoptic video images of this patient's hypopharynx demonstrate the pharyngeal splinting action of nasal CPAP thus applied. This is a novel approach to difficult intubation of the obese patient.