A comparison of ramping position and sniffing position during endotracheal intubation: A systematic review and meta-analysis

Tsan, Samuel Ern Hung and Ng, Ka Ting and Lau, Jiaying and Viknaswaran, Navian Lee and Wang, Chew Yin (2020) A comparison of ramping position and sniffing position during endotracheal intubation: A systematic review and meta-analysis. Brazilian Journal of Anesthesiology, 70 (6). pp. 667-677. ISSN 0034-7094, DOI https://doi.org/10.1016/j.bjan.2020.08.009. (In Press)

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Objectives: Positioning during endotracheal intubation (ETI) is critical to ensure its success. We aimed to determine if the ramping position improved laryngeal exposure and first attempt success at intubation when compared to the sniffing position. Methods: PubMed, EMBASE, and Cochrane CENTRAL databases were searched systematically from inception until January 2020. Our primary outcomes included laryngeal exposure as measured by Cormack-Lehane Grade 1 or 2 (CLG 1/2), CLG 3 or 4 (CLG 3/4), and first attempt success at intubation. Secondary outcomes were intubation time, use of airway adjuncts, ancillary maneuvers and complications during ETI. Results: Seven studies met our inclusion criteria, of which 4 were RCTs and 3 were cohort studies. The meta-analysis was conducted by pooling the effect estimates for all 4 included RCTs (n = 632). There were no differences found between ramping and sniffing positions for odds of CLG 1/2, CLG 3/4, first attempt success at intubation, intubation time, use of ancillary airway maneuvers and use of airway adjuncts, with evidence of high heterogeneity across studies. However, the ramping position in surgical patients is associated with increased likelihood of CLG 1/2 (OR =2.05, 95% CI 1.26 to 3.32, p= 0.004) and lower likelihood of CLG 3/4 (OR = 0.49, 95% CI 0.30 to 0.79, p= 0.004), moderate quality of evidence. Conclusion: Our meta-analysis demonstrated that the ramping position may benefit surgical patients undergoing ETI by improving laryngeal exposure. Large-scale well-designed multicentre RCTs should be carried out to further elucidate the benefits of the ramping position in the surgical and intensive care unit patients. (C) 2020 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia.

Item Type: Article
Uncontrolled Keywords: Ramping position; Sniffing position; Endotracheat intubation; Laryngeal exposure; Intubation success
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine > Anaesthesiology Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 20 May 2023 03:47
Last Modified: 20 May 2023 03:47
URI: http://eprints.um.edu.my/id/eprint/37195

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