CHECK-UP Trial Summary: Ramped vs Sniffing Position for Intubation

CHECK UP trial endotracheal intubation position

2017 CHECK-UP: POSITION- Ramped position vs Sniffing position during endotracheal intubation of critically ill adults 2 x 2 factorial design,randomised, multicentre,pragmatic trial 9 5 Objective: To evaluate the reduction in incidence of oxygen desaturation in ramped position as compared to sniffing position in emergency intubation in critically ill ICU patients 260 patients Patients >18 yrs undergoing endotracheal intubation by critical care or pulmonary fellows in the medical ICU Ramped position (n=130) Sniffing position (n=130) PRIMARY OUTCOME Median lowest arterial 02 saturation % P=0.27 SECONDARY OUTCOME 25.4 % Incidence of grade III or IV intubatio view P=0.01 11.5 12.3 % Incidence of difficult intubation P= 0.04 4.6 76.2 Rate of intubation on the 1st attempt % P=0.02 85.4 Conclusion: The Ramped position did not improve oxygenation during endotracheal intubation of critically ill adults as compared with the sniffing position but did increase the difficulty of intubation and the likelihood of repeated attempts. MW Semler et al. Chest 2017, 152(4):712-722