How to position your patient prior to intubation: ramped vs. sniffing

We still don’t know what’s the best way to position our patients to intubate them; ramped position (torso and head elevated) which has had some theoretical OR benefits vs. sniffing position (torso supine, neck flexed forward, and head extended). Patients did worse with the ramped position. An important takeaway is listed below. I do recommend that you add the Cormack-Lehane Grade views to your airway notes. This, combined with what medications you used, what size glidescope or blade you used definitely helps with future intubations. You should learn to look for prior intubation notes to prepare for difficult airways. All it takes is one bad one and your confidence will be shattered. Don’t let it happen to you. A hat tip to the investigators. 

A Multicenter, Randomized Trial of Ramped Position vs Sniffing Position During Endotracheal Intubation of Critically Ill Adults

Semler, Matthew W.Janz, David R. et al.

http://journal.chestnet.org/article/S0012-3692(17)30881-4/fulltext

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