Saturday, June 11, 2016

Head-up Intubation

SCANCRIT - Posted on June 10, 2016 - By K
"In anaesthetics we are trained to pre-oxygenate and intubate our theatre patients in a flat supine position. Then, when we graduate to intubating the really crook ICU/ED patients in severe heart or respiratory failure, we wise up. A paper in Anaesthesia & Analgesia demonstrates how patients who are intubated in a semi-sitting position are less likely to suffer complications when intubated.
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Take-home message
  • I have colleagues, very few, who insist on intubating high-risk patients with their heads down. They argue that this way gastric contents will clear more easily, preventing aspiration. I don´t buy into that nonsense.
  • The more concerned I am about the patient and the intubation, the more likely I am to elevate the back. Pre-oxygenation improves with heads up positioning, laryngoscopy views improve and complications are less likely to occur.
  • Shouldn’t then a lot more patients, including the ‘healthy’ OR patients, be intubated in a BUHE position? Patients in circulatory shock or with spinal injury might not tolerate non-supine positioning, but the others, the vast majority?"