Patients Should Be Intubated in an Upright, Head-Forward Position

Desaturation and poor direct laryngeal views are two important factors leading to intubation failure. In the operating room (OR), direct laryngoscopy is easier when patients are positioned with their backs up and heads forward (head of bed elevated ≥30°), which tends to align the anatomic axes of the upper airway, yielding better glottic visualization. In addition, preoxygenation is more effective when patients are upright. Whether this patient position protects against adverse events during emergent intubation outside the OR is unknown.

To assess whether complications are less likely when patients are intubated in a head-forward position versus a supine position, investigators at a tertiary care academic medical center retrospectively exami…