Although the esophago-tracheal combitube (ETC) has been shown to be reliable for mechanical ventilation for long periods,¹ the device is not suitable for ICU care, because it neither permits suctioning of the airway nor does it strictly prevent tracheal aspiration of gastric contents. Furthermore, prolonged inflation of the large oropharyngeal balloon could potentially lead to nerve compression in the oral cavity. A patient with difficult ventilation or intubation in whom an ETC is required will likely require definitive tracheal intubation for continued care in the operating room or critical care units. A fiberoptic bronchoscope (FOB) is a viable option for ensuring safe transition from supraglottic to intratracheal ventilation, without removing the lifesaving ETC device until the endotracheal tube (ETT) is securely in place. The ETC is moved to the left side of the mouth, the oropharyngeal balloon is deflated, and the FOB is inserted. After locating the glottis, the larynx and trachea are entered, and the ETT advanced. If desaturation occurs during the procedure, the oropharyngeal balloon can be quickly reinflated, and ventilation initiated, until oxygen saturations once again permit a brief period of apnea.

Evidence for this combination of techniques is limited to anecdotal reports.²