Have I Really Accomplished More Than 6000 Fiberoptic Intubations?

Yes.  Really.  Starting in late October 2004, I kept careful records of all my endoscopic intubations. Taking into account days off—vacation, post-call, holidays, family leave, etc.—I worked about ten months per year and consistently performed well more than 400 endoscopic intubations per year. In mid-June of 2014, I accomplished my 4000th endoscopic intubation.  I calculate this took me about 98 months to accomplish, for an average of about 41 intubations per month.  Nothing has changed in my practice since then.  I continue to routinely accomplish an average of about 40-45 endoscopic intubations per month, every month.  As of this writing (2000), well more than 400 flexible intubations per year times 15-plus years equals well more than 6000 intubations.

Please bear in mind I am not boasting here.  I am simply reporting actual experience. 

Now, these are solid numbers, but I wouldn’t be surprised if there are clinicians out there who have done a lot more.  Several of my partners have also accomplished thousands of endoscopic intubations.  They are all experts at this skill in their own right.

When I ask my other colleagues how many intubations of any kind they accomplish in a year, they typically don’t know.  It’s just not something that a busy clinician keeps track of.

Many paramedics and flight nurses perform less than 6 intubations per year, each of them utilizing either a standard or a video laryngoscope.  Of course, there are multiple exceptions to this.  Many urgent care physicians, emergency physicians, and hospitalists perform less than a dozen intubations in a year.  Again, there are a lot of exceptions to this.  But these intubations are almost all performed with a standard or video laryngoscope. 

How many intubations an anesthesiologist or an anesthesia mid-level practitioner performs in a year varies quite a bit.  It depends on multiple factors—full-time versus part-time practice, academic versus private practice, doctor-only versus care-team practice, surgery center versus hospital cases, amount of OB coverage, amount of regional anesthesia cases, percentage of supra-glottic airways and so forth.  Again, the overwhelming majority of these intubations are performed with a standard or video laryngoscope.

Many (most?) clinicians perform few if any flexible endoscopic intubations in a typical year.  In an entire career, perhaps a few dozen, if even that much.  It’s just not a tool they are comfortable using, so they tend to avoid it, even in the case of a difficult or emergency intubation. 

But I continue to advocate for the employment of flexible endoscopic bronchoscopy in routine, difficult and emergency airways.  In the overwhelming majority of cases, this makes total sense.