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. 2020 Mar 13;1(3):257-262.
doi: 10.1002/emp2.12035. eCollection 2020 Jun.

Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position

Dhimitri A Nikolla  1 , Ryann R Beaumont  1 , Jessica L Lerman  1 , Joseph S Datsko  1 , Jestin N Carlson  1
Affiliations

Impact of bed angle and height on intubation success during simulated endotracheal intubation in the ramped position

Dhimitri A Nikolla et al. J Am Coll Emerg Physicians Open. .

Abstract

Objective: The ramped position is often used during endotracheal intubation to improve oxygenation, improve laryngeal views, and reduce airway complications. We sought to compare the impact of ramp angle and bed height on intubation outcomes during simulated endotracheal intubation.

Methods: We enrolled emergency medicine residents and fourth-year medical students to perform simulated direct laryngoscopy and endotracheal intubation in random order with the mannequin in the following combinations of ramp angles and bed heights; ramp angles of 25° and 45° at bed heights including knee, mid-thigh, umbilicus, xiphoid, and nipple/intermammary fold. Our primary outcome was the reported percentage of glottic opening (POGO) score. Secondary outcomes included number of laryngoscopy attempts and intubation time.

Results: We enrolled 25 participants. There was no difference in reported POGO scores at 25° between bed heights, but at 45°, the umbilicus bed height had an improved reported POGO score (20; 95% confidence interval [CI] 7-33, P < 0.01) relative to xyphoid. The nipple/inframammary fold height required longer intubation times in seconds (mean difference [MD] 95% CI) at 25°, (MD, 23.9 [4.6-37.6], P < 0.01) and more laryngoscopy attempts at 45° (MD, 0.48 [0.16-0.79], P < 0.01) relative to xyphoid. There was no difference in laryngoscopy attempts and video POGO between 25° and 45° at all bed heights, but reported POGO at the umbilicus position was better at 25° than 45° (12 [1-23], P = 0.03).

Conclusion: The umbilicus bed height resulted in the highest reported POGO at 45°. Nipple/inframammary fold height resulted in worse intubating conditions.

Keywords: airway management; hypoxia; intratracheal; intubation; laryngoscopy; position; respiratory insufficiency; simulation.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Example of bed height at the umbilicus of the intubator and bed angle at 25°
FIGURE 2
FIGURE 2
Kaplan‐Meier estimates by bed height with the bed ramped to either 25° (3a) or 45° (3b). (A) Bed ramped to 25°. (B) Bed ramped to 45°
See this image and copyright information in PMC

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