A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis
Objectives: Positioning during endotracheal intubation (ETI) is critical to ensure its success. We aimed to determine if the ramping position improved laryngeal exposure and first attempt success at intubation when compared to the sniffing position. Methods: PubMed, EMBASE, and Cochrane CENTRAL d...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Braz J Anesthesiol
2020
|
| Subjects: | |
| Online Access: | http://ir.unimas.my/id/eprint/36633/1/samuel1.pdf http://ir.unimas.my/id/eprint/36633/ https://www.bjan-sba.org/journal/rba/article/doi/10.1016/j.bjane.2020.10.007 https://doi.org/10.1016/j.bjane.2020.10.007 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Objectives: Positioning during endotracheal intubation (ETI) is critical to ensure its success.
We aimed to determine if the ramping position improved laryngeal exposure and first attempt
success at intubation when compared to the sniffing position.
Methods: PubMed, EMBASE, and Cochrane CENTRAL databases were searched systematically
from inception until January 2020. Our primary outcomes included laryngeal exposure as measured by Cormack-Lehane Grade 1 or 2 (CLG 1/2), CLG 3 or 4 (CLG 3/4), and first attempt success
at intubation. Secondary outcomes were intubation time, use of airway adjuncts, ancillary
maneuvers, and complications during ETI.
Results: Seven studies met our inclusion criteria, of which 4 were RCTs and 3 were cohort
studies. The meta-analysis was conducted by pooling the effect estimates for all 4 included RCTs
(n = 632). There were no differences found between ramping and sniffing positions for odds of
CLG 1/2, CLG 3/4, first attempt success at intubation, intubation time, use of ancillary airway
maneuvers, and use of airway adjuncts, with evidence of high heterogeneity across studies.
However, the ramping position in surgical patients is associated with increased likelihood of
CLG 1/2 (OR = 2.05, 95% CI 1.26 to 3.32, p = 0.004) and lower likelihood of CLG 3/4 (OR = 0.49,
95% CI 0.30 to 0.79, p = 0.004), moderate quality of evidence.Conclusion: Our meta-analysis demonstrated that the ramping position may benefit surgical
patients undergoing ETI by improving laryngeal exposure. Large scale well designed multicentre
RCTs should be carried out to further elucidate the benefits of the ramping position in the
surgical and intensive care unit patients.
© 2020 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/). |
|---|