Journal
CHEST
Volume 152, Issue 4, Pages 712-722Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.chest.2017.03.061
Keywords
endotracheal intubation; hypoxemia; randomized trial
Categories
Funding
- National Heart, Lung, and Blood Institute [HL087738 09]
- Vanderbilt Institute for Clinical and Translational Research [National Center for Advancing Translational Sciences/National Institutes of Health] [UL1 TR000445]
Ask authors/readers for more resources
BACKGROUND: Hypoxemia is the most common complication during endotracheal intubation of critically ill adults. Intubation in the ramped position has been hypothesized to prevent hypoxemia by increasing functional residual capacity and decreasing the duration of intubation, but has never been studied outside of the operating room. METHODS: Multicenter, randomized trial comparing the ramped position (head of the bed elevated to 25 degrees)with the sniffing position (torso supine, neck flexed, and head extended) among 260 adults undergoing endotracheal intubation by pulmonary and critical care medicine fellows in four ICUs between July 22, 2015, and July 19, 2016. The primary outcome was lowest arterial oxygen saturation between induction and 2 minutes after intubation. Secondary outcomes included Cormack-Lehane grade of glottic view, difficulty of intubation, and number of laryngoscopy attempts. RESULTS: The median lowest arterial oxygen saturation was 93% (interquartile range [IQR], 84%-99%) with the ramped position vs 92% (IQR, 79%-98%) with the sniffing position (P-.27). The ramped position appeared to increase the incidence of grade III or IV view (25.4% vs 11.5%, P-.01), increase the incidence of difficult intubation (12.3% vs 4.6%, P-.04), and decrease the rate of intubation on the first attempt (76.2% vs 85.4%, P-.02), respectively. CONCLUSIONS: In this multicenter trial, the ramped position did not improve oxygenation during endotracheal intubation of critically ill adults compared with the sniffing position. The ramped position may worsen glottic view and increase the number of laryngoscopy attempts required for successful intubation.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available