Tags

Type your tag names separated by a space and hit enter

Multicenter Comparison of Nonsupine Versus Supine Positioning During Intubation in the Emergency Department: A National Emergency Airway Registry (NEAR) Study.

Abstract

OBJECTIVE

Head-up positioning for preoxygenation and ramping for morbidly obese patients are well-accepted techniques, but the effect of head-up positioning with full torso elevation for all intubations is controversial. We compared first-pass success, adverse events, and glottic view between supine (SP) and nonsupine (NSP) positioning for emergency department (ED) patients undergoing orotracheal intubation.

METHODS

We performed a retrospective analysis of prospectively collected data for ED intubations over a 2-year period from 25 participating centers in the National Emergency Airway Registry (NEAR). We compared characteristics and outcomes for adult patients intubated orotracheally in SP and NSP positions with either a direct or video laryngoscope. We report odds ratios (OR) with 95% confidence interval (CI) for categorical variables and interquartile ranges with 95% CI for continuous variables. Our primary outcome was first-attempt intubation success and secondary outcomes were glottic views and peri-intubation adverse events.

RESULTS

Of 11,480 total intubations, 5.8% were performed in NSP. The NSP group included significantly more obese patients (OR = 2.2 [95% CI = 1.9-2.6]) and patients with a suspected difficult airway (OR = 1.8 [95% CI = 1.6-2.2]). First-pass success (adjusted OR = 1.1 [95% CI = 0.9-1.4]) and overall rate of grade I glottic views (OR = 1.1 [95% CI = 0.9-1.2]) were similar between groups while NSP had a significantly higher rate of grade I views when direct laryngoscopy was employed (OR = 1.27 [95% CI = 1.04-1.54]). NSP was associated with higher odds of any adverse event (OR = 1.4 [95% CI = 1.1-1.7]).

CONCLUSIONS

ED providers utilized SP in most ED intubations but were more likely to use NSP for patients who were obese or in whom they predicted a difficult airway. We found no differences in first-pass success between groups but total adverse events were more likely in NSP. A randomized trial comparing patient positioning during intubation in the ED is warranted.

Authors+Show Affiliations

Division of Emergency Medicine, University of Utah, Salt Lake City, UT.Division of Emergency Medicine, University of Utah, Salt Lake City, UT.Department of Emergency Medicine, Harbor-UCLA, Torrance, CA.Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.Division of Emergency Medicine, University of Utah, Salt Lake City, UT.Division of Emergency Medicine, University of Utah, Salt Lake City, UT.Division of Emergency Medicine, University of Utah, Salt Lake City, UT.Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31116893

Citation

Stoecklein, H Hill, et al. "Multicenter Comparison of Nonsupine Versus Supine Positioning During Intubation in the Emergency Department: a National Emergency Airway Registry (NEAR) Study." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 2019.
Stoecklein HH, Kelly C, Kaji AH, et al. Multicenter Comparison of Nonsupine Versus Supine Positioning During Intubation in the Emergency Department: A National Emergency Airway Registry (NEAR) Study. Acad Emerg Med. 2019.
Stoecklein, H. H., Kelly, C., Kaji, A. H., Fantegrossi, A., Carlson, M., Fix, M. L., ... Brown, C. A. (2019). Multicenter Comparison of Nonsupine Versus Supine Positioning During Intubation in the Emergency Department: A National Emergency Airway Registry (NEAR) Study. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, doi:10.1111/acem.13805.
Stoecklein HH, et al. Multicenter Comparison of Nonsupine Versus Supine Positioning During Intubation in the Emergency Department: a National Emergency Airway Registry (NEAR) Study. Acad Emerg Med. 2019 May 22; PubMed PMID: 31116893.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multicenter Comparison of Nonsupine Versus Supine Positioning During Intubation in the Emergency Department: A National Emergency Airway Registry (NEAR) Study. AU - Stoecklein,H Hill, AU - Kelly,Christopher, AU - Kaji,Amy H, AU - Fantegrossi,Andrea, AU - Carlson,Margaret, AU - Fix,Megan L, AU - Madsen,Troy, AU - Walls,Ron M, AU - Brown,Calvin A,3rd AU - ,, Y1 - 2019/05/22/ PY - 2019/01/16/received PY - 2019/05/11/revised PY - 2019/05/18/accepted PY - 2019/5/23/pubmed PY - 2019/5/23/medline PY - 2019/5/23/entrez JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med N2 - OBJECTIVE: Head-up positioning for preoxygenation and ramping for morbidly obese patients are well-accepted techniques, but the effect of head-up positioning with full torso elevation for all intubations is controversial. We compared first-pass success, adverse events, and glottic view between supine (SP) and nonsupine (NSP) positioning for emergency department (ED) patients undergoing orotracheal intubation. METHODS: We performed a retrospective analysis of prospectively collected data for ED intubations over a 2-year period from 25 participating centers in the National Emergency Airway Registry (NEAR). We compared characteristics and outcomes for adult patients intubated orotracheally in SP and NSP positions with either a direct or video laryngoscope. We report odds ratios (OR) with 95% confidence interval (CI) for categorical variables and interquartile ranges with 95% CI for continuous variables. Our primary outcome was first-attempt intubation success and secondary outcomes were glottic views and peri-intubation adverse events. RESULTS: Of 11,480 total intubations, 5.8% were performed in NSP. The NSP group included significantly more obese patients (OR = 2.2 [95% CI = 1.9-2.6]) and patients with a suspected difficult airway (OR = 1.8 [95% CI = 1.6-2.2]). First-pass success (adjusted OR = 1.1 [95% CI = 0.9-1.4]) and overall rate of grade I glottic views (OR = 1.1 [95% CI = 0.9-1.2]) were similar between groups while NSP had a significantly higher rate of grade I views when direct laryngoscopy was employed (OR = 1.27 [95% CI = 1.04-1.54]). NSP was associated with higher odds of any adverse event (OR = 1.4 [95% CI = 1.1-1.7]). CONCLUSIONS: ED providers utilized SP in most ED intubations but were more likely to use NSP for patients who were obese or in whom they predicted a difficult airway. We found no differences in first-pass success between groups but total adverse events were more likely in NSP. A randomized trial comparing patient positioning during intubation in the ED is warranted. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/31116893/Multicenter_Comparison_of_Nonsupine_Versus_Supine_Positioning_During_Intubation_in_the_Emergency_Department:_A_National_Emergency_Airway_Registry_(NEAR)_Study L2 - https://doi.org/10.1111/acem.13805 DB - PRIME DP - Unbound Medicine ER -