Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position
Abstract Objective The ramped position is often used during endotracheal intubation to improve oxygenation, improve laryngeal views, and reduce airway complications. We sought to compare the impact of ramp angle and bed height on intubation outcomes during simulated endotracheal intubation. Methods...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-06-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12035 |
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| author | Dhimitri A. Nikolla Ryann R. Beaumont Jessica L. Lerman Joseph S. Datsko Jestin N. Carlson |
| author_facet | Dhimitri A. Nikolla Ryann R. Beaumont Jessica L. Lerman Joseph S. Datsko Jestin N. Carlson |
| author_sort | Dhimitri A. Nikolla |
| collection | DOAJ |
| description | Abstract Objective The ramped position is often used during endotracheal intubation to improve oxygenation, improve laryngeal views, and reduce airway complications. We sought to compare the impact of ramp angle and bed height on intubation outcomes during simulated endotracheal intubation. Methods We enrolled emergency medicine residents and fourth‐year medical students to perform simulated direct laryngoscopy and endotracheal intubation in random order with the mannequin in the following combinations of ramp angles and bed heights; ramp angles of 25° and 45° at bed heights including knee, mid‐thigh, umbilicus, xiphoid, and nipple/intermammary fold. Our primary outcome was the reported percentage of glottic opening (POGO) score. Secondary outcomes included number of laryngoscopy attempts and intubation time. Results We enrolled 25 participants. There was no difference in reported POGO scores at 25° between bed heights, but at 45°, the umbilicus bed height had an improved reported POGO score (20; 95% confidence interval [CI] 7–33, P < 0.01) relative to xyphoid. The nipple/inframammary fold height required longer intubation times in seconds (mean difference [MD] 95% CI) at 25°, (MD, 23.9 [4.6–37.6], P < 0.01) and more laryngoscopy attempts at 45° (MD, 0.48 [0.16–0.79], P < 0.01) relative to xyphoid. There was no difference in laryngoscopy attempts and video POGO between 25° and 45° at all bed heights, but reported POGO at the umbilicus position was better at 25° than 45° (12 [1–23], P = 0.03). Conclusion The umbilicus bed height resulted in the highest reported POGO at 45°. Nipple/inframammary fold height resulted in worse intubating conditions. |
| format | Article |
| id | doaj-art-80705d23309f4a859227a6d1d8d849ea |
| institution | DOAJ |
| issn | 2688-1152 |
| language | English |
| publishDate | 2020-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-80705d23309f4a859227a6d1d8d849ea2025-08-20T03:04:01ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522020-06-011325726210.1002/emp2.12035Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped positionDhimitri A. Nikolla0Ryann R. Beaumont1Jessica L. Lerman2Joseph S. Datsko3Jestin N. Carlson4Department of Emergency Medicine Allegheny Health Network—Saint Vincent Hospital, Erie PennsylvaniaDepartment of Emergency Medicine Allegheny Health Network—Saint Vincent Hospital, Erie PennsylvaniaDepartment of Emergency Medicine Allegheny Health Network—Saint Vincent Hospital, Erie PennsylvaniaDepartment of Emergency Medicine Allegheny Health Network—Saint Vincent Hospital, Erie PennsylvaniaDepartment of Emergency Medicine Allegheny Health Network—Saint Vincent Hospital, Erie PennsylvaniaAbstract Objective The ramped position is often used during endotracheal intubation to improve oxygenation, improve laryngeal views, and reduce airway complications. We sought to compare the impact of ramp angle and bed height on intubation outcomes during simulated endotracheal intubation. Methods We enrolled emergency medicine residents and fourth‐year medical students to perform simulated direct laryngoscopy and endotracheal intubation in random order with the mannequin in the following combinations of ramp angles and bed heights; ramp angles of 25° and 45° at bed heights including knee, mid‐thigh, umbilicus, xiphoid, and nipple/intermammary fold. Our primary outcome was the reported percentage of glottic opening (POGO) score. Secondary outcomes included number of laryngoscopy attempts and intubation time. Results We enrolled 25 participants. There was no difference in reported POGO scores at 25° between bed heights, but at 45°, the umbilicus bed height had an improved reported POGO score (20; 95% confidence interval [CI] 7–33, P < 0.01) relative to xyphoid. The nipple/inframammary fold height required longer intubation times in seconds (mean difference [MD] 95% CI) at 25°, (MD, 23.9 [4.6–37.6], P < 0.01) and more laryngoscopy attempts at 45° (MD, 0.48 [0.16–0.79], P < 0.01) relative to xyphoid. There was no difference in laryngoscopy attempts and video POGO between 25° and 45° at all bed heights, but reported POGO at the umbilicus position was better at 25° than 45° (12 [1–23], P = 0.03). Conclusion The umbilicus bed height resulted in the highest reported POGO at 45°. Nipple/inframammary fold height resulted in worse intubating conditions.https://doi.org/10.1002/emp2.12035airway managementhypoxiaintratrachealintubationlaryngoscopyposition |
| spellingShingle | Dhimitri A. Nikolla Ryann R. Beaumont Jessica L. Lerman Joseph S. Datsko Jestin N. Carlson Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position Journal of the American College of Emergency Physicians Open airway management hypoxia intratracheal intubation laryngoscopy position |
| title | Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position |
| title_full | Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position |
| title_fullStr | Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position |
| title_full_unstemmed | Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position |
| title_short | Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position |
| title_sort | impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position |
| topic | airway management hypoxia intratracheal intubation laryngoscopy position |
| url | https://doi.org/10.1002/emp2.12035 |
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