Cover Image

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...

Full description

Saved in:
Bibliographic Details
Main Authors: Samuel Ern Hung, Tsan, Ka Ting, Ng, Jiaying, Lau, Navian Lee, Viknaswaran, Chew Yin, Wang
Format: Article
Language:English
Published: Braz J Anesthesiol 2020
Subjects:
R Medicine (General)
RD Surgery
RZ Other systems of medicine
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!
id my.unimas.ir.36633
record_format eprints
spelling my.unimas.ir.366332021-11-08T04:56:11Z http://ir.unimas.my/id/eprint/36633/ A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis Samuel Ern Hung, Tsan Ka Ting, Ng Jiaying, Lau Navian Lee, Viknaswaran Chew Yin, Wang R Medicine (General) RD Surgery RZ Other systems of medicine 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/). Braz J Anesthesiol 2020-11-04 Article PeerReviewed text en http://ir.unimas.my/id/eprint/36633/1/samuel1.pdf Samuel Ern Hung, Tsan and Ka Ting, Ng and Jiaying, Lau and Navian Lee, Viknaswaran and Chew Yin, Wang (2020) A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis. Brazilian Journal of Anesthesiology, 70 (6). pp. 667-677. ISSN 2352-2291 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
institution Universiti Malaysia Sarawak
building Centre for Academic Information Services (CAIS)
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaysia Sarawak
content_source UNIMAS Institutional Repository
url_provider http://ir.unimas.my/
language English
topic R Medicine (General)
RD Surgery
RZ Other systems of medicine
spellingShingle R Medicine (General)
RD Surgery
RZ Other systems of medicine
Samuel Ern Hung, Tsan
Ka Ting, Ng
Jiaying, Lau
Navian Lee, Viknaswaran
Chew Yin, Wang
A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis
description 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/).
format Article
author Samuel Ern Hung, Tsan
Ka Ting, Ng
Jiaying, Lau
Navian Lee, Viknaswaran
Chew Yin, Wang
author_facet Samuel Ern Hung, Tsan
Ka Ting, Ng
Jiaying, Lau
Navian Lee, Viknaswaran
Chew Yin, Wang
author_sort Samuel Ern Hung, Tsan
title A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis
title_short A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis
title_full A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis
title_fullStr A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis
title_full_unstemmed A comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis
title_sort comparison of ramping position and sniffing position during endotracheal intubation: a systematic review and meta-analysis
publisher Braz J Anesthesiol
publishDate 2020
url 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
_version_ 1717097753337659392
score 13.211869

Similar Items