Seated vs. Supine Patient Positioning for Emergency Intubation

Prior research has suggested that patients should be intubated emergently in an upright, head-forward position rather than in the traditional supine position (NEJM JW Emerg Med Mar 15 2016; [e-pub] and Anesth Analg 2016; 122:1101).

To examine this issue further, investigators analyzed 231 intubations performed in two emergency departments (EDs) by 58 residents affiliated with a single residency program. Patient positioning was chosen at convenience, the angle of elevation of the bed was measured, and first-attempt intubation success rates were recorded.

First-attempt success was attained in 66% of supine intubations, 78% of inclined intubations, and 86% of upright intubations (angle of bed, ≥45 degrees).