Effect of Upright Patient Positioning on Intubation Success

Indiana University

Status: Completed

Conditions: Intubation

Treatments: Procedure: Upright intubation

Study type: Observational

Funder types: Other

Identifiers

NCT02885298

1405954059

Details and patient eligibility

About

Endotracheal intubation is most commonly taught and performed with the patient supine. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on success rates of upright intubation in the emergency department. The goal of this study was to measure the association of head positioning with intubation success rates among emergency medicine residents.

Full description

Endotracheal intubation is most commonly taught and performed with the patient supine. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on success rates of upright intubation in the emergency department. The goal of this study was to measure the association of head positioning with intubation success rates among emergency medicine residents. Study design was a prospective observational study. Residents performing intubation recorded the angle of the head of the bed, and the number of attempts required for successful intubation was recorded by faculty and respiratory therapists. The primary outcome of first past success was calculated with respect to three groups: 0-10 degrees (supine), 11-44 degrees (inclined), and ≥45 degrees (upright); first past success was also analyzed in 5 degree angle increments.

Enrollment: 232 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adult medical intubations in which the intubating resident and supervising faculty both consented to study participation.

Exclusion criteria

• Pediatric patients
• Obstetric patients
• Trauma patients

Trial design

232 participants in 3 patient groups

Supine intubations (0-10 degrees)

Description:

Intubations performed with patient positioned 0-10 degrees. Patient supine.

Treatment:

Procedure: Upright intubation

Inclined (11-44 degrees)

Description:

Intubations performed with 11-44 degrees of elevation.

Treatment:

Procedure: Upright intubation

Upright (45 degrees or greater)

Description:

intubations performed with patient elevated to 45 degrees or greater

Treatment:

Procedure: Upright intubation