Yohei Okada1, Yujiro Nakayama2, Katsuhiko Hashimoto2, Kaoru Koike3, Norio Watanabe4. 1. Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan. Electronic address: yokada-kyf@umin.ac.jp. 2. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan. 3. Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 4. Department of Health Promotion and Human Behavior, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Abstract
BACKGROUND: Whether the ramped or sniffing laryngoscopy position is better for tracheal intubation is unclear. This study aimed to determine the efficacy and safety of tracheal intubation in the ramped versus sniffing position. METHODS: We conducted a systematic review and meta-analysis of randomized clinical trials to compare the ramped position with the sniffing position for tracheal intubation. We searched the databases of Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Excerpta Medica Database (Embase), ClinicalTrials.gov, and World Health Organization Clinical Trials Registry Platform up to December 2018. We included randomized-controlled trials, trials of participants who required tracheal intubation in any setting, and that compared tracheal intubation in the ramped and the sniffing positions. Two authors independently screened the trials, extracted the data, and assessed the risk of bias. We conducted the meta-analysis using the random-effects model to calculate the pooled risk ratio with 95% confidence interval. RESULTS: Of the 2631 titles/abstracts screened, three studies (representing 513 patients) were included in the meta-analysis. The pooled risk ratio with 95% confidence interval (CI) of the sniffing versus the ramped position was as follows: a first successful attempt, 0.97 (95% CI, 0.86-1.09; I2 = 55%); laryngoscopy attempts ≤2, 1.08 (95% CI, 0.88-1.31; I2 = 93%); and good glottic view with Cormack-Lehane grade ≤ 2, 0.86 (95% CI, 0.69-1.07; I2 = 86%). CONCLUSIONS: This systematic review and meta-analysis indicated no favorable aspects of the ramped position as compared to the sniffing position. Thus, further research is warranted to identify which is better in tracheal intubation. TRIAL REGISTRATION: PROSPERO identifier, CRD42019116819.
BACKGROUND: Whether the ramped or sniffing laryngoscopy position is better for tracheal intubation is unclear. This study aimed to determine the efficacy and safety of tracheal intubation in the ramped versus sniffing position. METHODS: We conducted a systematic review and meta-analysis of randomized clinical trials to compare the ramped position with the sniffing position for tracheal intubation. We searched the databases of Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Excerpta Medica Database (Embase), ClinicalTrials.gov, and World Health Organization Clinical Trials Registry Platform up to December 2018. We included randomized-controlled trials, trials of participants who required tracheal intubation in any setting, and that compared tracheal intubation in the ramped and the sniffing positions. Two authors independently screened the trials, extracted the data, and assessed the risk of bias. We conducted the meta-analysis using the random-effects model to calculate the pooled risk ratio with 95% confidence interval. RESULTS: Of the 2631 titles/abstracts screened, three studies (representing 513 patients) were included in the meta-analysis. The pooled risk ratio with 95% confidence interval (CI) of the sniffing versus the ramped position was as follows: a first successful attempt, 0.97 (95% CI, 0.86-1.09; I2 = 55%); laryngoscopy attempts ≤2, 1.08 (95% CI, 0.88-1.31; I2 = 93%); and good glottic view with Cormack-Lehane grade ≤ 2, 0.86 (95% CI, 0.69-1.07; I2 = 86%). CONCLUSIONS: This systematic review and meta-analysis indicated no favorable aspects of the ramped position as compared to the sniffing position. Thus, further research is warranted to identify which is better in tracheal intubation. TRIAL REGISTRATION: PROSPERO identifier, CRD42019116819.
Authors: Morgan Le Guen; Zoé Coppere; Guillaume Dufour; Jonathan Ouattara; Julie Trichereau; Marc Fischler Journal: BMJ Open Date: 2020-07-08 Impact factor: 2.692