Intubation
Conditions
Brief summary
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.
Detailed 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.
Interventions
PROCEDUREUpright intubation
Upright Intubation procedure performed with patient elevated above the supine position. Defined as upright greater to or equal to 45 degrees or inclined 10-44 degrees
Sponsors
Indiana University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| First Pass Success | Immediately at the time of the procedure | An attempt was defined as anytime the laryngoscope blade was placed in the patient's mouth. At the beginning of the study residents, faculty, and RTs were educated on this definition. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time required for successful intubation | Immediately at the time of the procedure | endotracheal tube in place |
| esophageal intubation | Immediately at the time of the procedure | endotracheal tube determined to be positioned in esophagus rather |
| cardiac arrest within 30 minutes of the intubation attempt | cardiac arrest within 30 minutes of intubation | — |
| decrease in oxygen saturation during the procedure | Immediately at the time of the procedure | — |
| best Cormack-Lehane view | Immediately at the time of the procedure | Cormack-Lehane view is a scale that is used to describe the amount of vocal cords visualized during the procedure |
| overall success rate of orotracheal intubation overall success rate of orotracheal intubation overall success rate of intubation | Immediately at the time of the procedure | endotracheal tube in place |
| Resident Satisfaction with Positioning | following procedure | survey completed following the procedure by provider regarding satisfaction |
| death in ED | While in the emergency department (1 hour up to 1 day) | — |
| death within 5 days of intubation | Death within 5 days following intubation | any cause of death within 5 days after intubation |
| New pneumonia | within 5 days following intubation | new pneumonia developed within 5 days following an intubation. Not present on admission. |
| best Percent of Glottic Opening (POGO) | obtained during the procedure | Percent of glottis opening refers to the percentage of vocal cords and surrounding anatomy which can be seen during the procedure |
Outcome results
None listed