Thursday, August 1, 2019

Head Elevation during Intubation

R.E.B.E.L.EM - August 01, 2019 - By Bryant R
  • Pre-oxygenation and intubation in HOB elevated position makes physiologic sense.
  • Pre-oxygenating obese and non obese patients undergoing elective surgery in HOB elevated position can prolong the non patient oriented outcome of safe apnea duration by over 1 minute. This supports the physiologic plausibility of HOB elevation improving respiratory dynamics.
  • Intubating non trauma and non cardiac arrest patients in a pre-hospital setting in a HOB elevated position is associated with improved first pass success, improved glottic visualization, and a decrease in the presence of airway secretions during laryngoscopy.
  • ED studies show mixed results with one study showing improved first pass success without a difference in peri-intubation hypoxia or rates of post intubation pneumonia. A larger registry-based study showed no difference in first pass success, but a higher incidence of peri-intubation hypoxia in the HOB elevated group that may have been a sicker population.
  • In-hospital studies are split, with one showing a dramatic reduction in peri-intubation adverse events with HOB elevation, and another showing a reduction in first pass success that may be associated with ICU bed design.
  • Equipment / position issues may be overcome with deliberate practice and increased experience.
  • For ED patients requiring intubation HOB elevation makes physiologic sense and is supported by prehospital and ED studies. There is no evidence of harm in the ED setting."