Effect of head-elevated versus neutral position on tracheal intubation using a hyper-angulated video laryngoscope under cervical spine immobilization: a randomised crossover trial - 28/02/26
Graphical abstract |
Highlights |
• | Hyper-angulated videolaryngoscopes improve glottic view in cervical spine immobilisation. |
• | Their use may complicate blade insertion and tracheal tube advancement. |
• | The head-elevated position shortened intubation time and reduced intubation difficulty. |
• | Blade and tube handling were easier with fewer optimisation manoeuvres. |
• | Findings support head-elevated position use during GlideScope® intubation with immobilisation. |
Abstract |
Background |
Videolaryngoscopes with hyper-angulated blades improve glottic visualisation in patients with cervical spine immobilisation but may complicate blade insertion and tracheal tube (TT) advancement. We compared the head-elevated (HE) and head-neutral (HN) position during GlideScope®-guided intubation under manual in-line stabilisation (MILS).
Methods |
In this randomised crossover trial, 180 adult patients undergoing elective surgery were allocated to HN or HE groups. Under MILS, videolaryngoscopy was performed in both positions, but intubation was attempted only in the second designed position. The HE position was achieved by elevating the back section of the table to align the external auditory meatus and sternal notch.
Results |
Intubation was attempted in 177 patients with 100% success. Median intubation time was shorter in HE group than HN group (27.2 [23.4–34.3] vs. 31.5 [27.0–40.5] s; difference –4.5 s, 95% CI –7.5 to –1.8; P = 0.001). The modified intubation difficulty scale was lower in HE group (1 [0–1]) than HN group (2 [1–3]; P < 0.001). The need for optimisation manoeuvres was less frequent in the HE position for GlideScope® blade insertion (5.6% vs. 13.9%; P = 0.0001) and for TT advancement (31.8% vs. 58.4%; P < 0.001). Laryngeal view was superior in the HE position, with a higher mean percentage of glottic opening score (42.9 ± 35.6% vs. 26.8 ± 32.3%; P < 0.0001) and a greater proportion of easy modified Cormack-Lehane grades (83.8% vs. 64.8%; P < 0.0001).
Conclusion |
The HE position significantly improved intubation efficiency and technical ease using a hyper-angulated videolaryngoscope under MILS.
Trial registration |
ClinicalTrials.gov identifier: NCT05671978.
Le texte complet de cet article est disponible en PDF.Keywords : Tracheal intubation, Videolaryngoscopy, Head-elevated position, Manual in-line stabilization, Cervical spine immobilization, GlideScope
Abbreviations : TT, HE, HN, ELM
Plan
Vol 45 - N° 4
Article 101720- juillet 2026 Retour au numéro
Article précédent
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