Check-UP Position
Trial question
What is the role of the ramped position during endotracheal intubation of critically ill adults?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
39.0% female
61.0% male
N = 260
260 patients (102 female, 158 male).
Inclusion criteria: adult patients undergoing endotracheal intubation in the ICU.
Key exclusion criteria: urgent need for intubation; treating clinicians felt a specific patient position was required for the safe performance of the procedure.
Interventions
N=130 ramped position (head of the bed elevated to 25 degree).
N=130 sniffing position (torso supine, neck flexed, and head extended).
Primary outcome
Lowest oxygen saturation
93%
92%
93.0 %
69.8 %
46.5 %
23.3 %
0.0 %
Ramped
position
Sniffing
position
No significant
difference ↔
No significant difference in lowest oxygen saturation (93% vs. 92%; AD 1%, 95% CI -0.77 to 2.77).
Secondary outcomes
Significant increase in incidence of grade III-IV view (25.4% vs. 11.5%; AD 13.9%, 95% CI 3.32 to 24.48).
Significant increase in difficulty in intubation (12.3% vs. 4.6%; AD 7.7%, 95% CI 0.34 to 15.06).
Significant decrease in rate of intubation on the first attempt (76.2% vs. 85.4%; ARD -9.2, 95% CI -16.96 to -1.44).
Safety outcomes
No significant differences in death within 1 hour of intubation or before hospital discharge, ventilator-free days.
Significant difference in use of endotracheal tube introducer (19.2% vs. 6.2%) and second laryngoscope type required (16.2% vs. 6.2%).
Conclusion
In adult patients undergoing endotracheal intubation in the ICU, ramped position was not superior to sniffing position with respect to lowest oxygen saturation.
Reference
Matthew W Semler, David R Janz, Derek W Russell et al. A Multicenter, Randomized Trial of Ramped Position vs Sniffing Position During Endotracheal Intubation of Critically Ill Adults. Chest. 2017 Oct;152(4):712-722.
Open reference URL