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NCT Number: NCT02885298

Effect of Upright Patient Positioning on Intubation Success

Endotracheal intubation is most commonly taught and performed with the patient supine. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on success rates of upright intubation in the emergency department. The goal of this study was to measure the association of head positioning with intubation success rates among emergency medicine residents.

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Key information

Conditions

Intubation

Age range

18 year and older

Sex eligibility

All sexes

Study type

Observational

About this study

Endotracheal intubation is most commonly taught and performed with the patient supine. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on success rates of upright intubation in the emergency department. The goal of this study was to measure the association of head positioning with intubation success rates among emergency medicine residents. Study design was a prospective observational study. Residents performing intubation recorded the angle of the head of the bed, and the number of attempts required for successful intubation was recorded by faculty and respiratory therapists. The primary outcome of first past success was calculated with respect to three groups: 0-10 degrees (supine), 11-44 degrees (inclined), and ≥45 degrees (upright); first past success was also analyzed in 5 degree angle increments.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Adult medical intubations in which the intubating resident and supervising faculty both consented to study participation.

Exclusion criteria

  • Pediatric patients
  • Obstetric patients
  • Trauma patients

Treatment and study plan

Upright intubation

Procedure

Upright Intubation procedure performed with patient elevated above the supine position. Defined as upright greater to or equal to 45 degrees or inclined 10-44 degrees

Primary outcomes

  1. First Pass Success

    Time frame: Immediately at the time of the procedure

    An attempt was defined as anytime the laryngoscope blade was placed in the patient's mouth. At the beginning of the study residents, faculty, and RTs were educated on this definition.

Secondary outcomes

  1. overall success rate of orotracheal intubation overall success rate of orotracheal intubation overall success rate of intubation

    Time frame: Immediately at the time of the procedure

    endotracheal tube in place

  2. Time required for successful intubation

    Time frame: Immediately at the time of the procedure

    endotracheal tube in place

  3. esophageal intubation

    Time frame: Immediately at the time of the procedure

    endotracheal tube determined to be positioned in esophagus rather

  4. cardiac arrest within 30 minutes of the intubation attempt

    Time frame: cardiac arrest within 30 minutes of intubation

  5. decrease in oxygen saturation during the procedure

    Time frame: Immediately at the time of the procedure

  6. best Cormack-Lehane view

    Time frame: Immediately at the time of the procedure

    Cormack-Lehane view is a scale that is used to describe the amount of vocal cords visualized during the procedure

  7. best Percent of Glottic Opening (POGO)

    Time frame: obtained during the procedure

    Percent of glottis opening refers to the percentage of vocal cords and surrounding anatomy which can be seen during the procedure

  8. Resident Satisfaction with Positioning

    Time frame: following procedure

    survey completed following the procedure by provider regarding satisfaction

  9. death in ED

    Time frame: While in the emergency department (1 hour up to 1 day)

  10. death within 5 days of intubation

    Time frame: Death within 5 days following intubation

    any cause of death within 5 days after intubation

  11. New pneumonia

    Time frame: within 5 days following intubation

    new pneumonia developed within 5 days following an intubation. Not present on admission.

Sponsors and collaborators

Lead sponsor

Indiana University

Other

Registry information

Official study title

Prospective Observational Study of the Effect of Upright Patient Positioning on Intubation Success Rates at Two Academic Emergency Departments

Important dates

Study start
2014
Primary completion
2016
Study completion
2016
First posted
Aug 31, 2016
Registry last updated
Aug 31, 2016

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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