Letters to the Editor: Letter to the Editor
To the Editor:
I read with interest the article by Khandelwal et al1 regarding the patient positioning for emergent tracheal intubation. Complications were less when direct laryngoscopy was performed in what the authors described as the “back-up head-elevated” position versus the supine position. However, the body position illustrated in the article is the reflex table body position (back-up, feet-up), and the head is in the sniffing position and not in the head-elevated position. Because tilting the patient’s back up from the horizontal (supine) position will also move the head up, all investigators use either back-up or head-up position interchangeably.2,3 The head-elevated position is another term that has been used to describe placing the head above and beyond the sniffing position.4 It refers to head position in relation to the neck and the rest of the body and not to the absolute horizontal. The term “head-elevated” position cannot, thus, be used interchangeably with the either “head-up” or “sniffing” head positions because they have different meanings. To avoid future confusion and erroneous conclusions when comparing the results from different studies, it is necessary to standardize positioning language.
Mohammad El-Orbany, MD
Department of Anesthesiology
Medical College of Wisconsin
1. Khandelwal N, Khorsand S, Mitchell SH, Joffe AM. Head-elevated patient positioning decreases complications of emergent tracheal intubation in the ward and intensive care unit. Anesth Analg. 2016;122:1101–1107.
2. Lee BJ, Kang JM, Kim DO. Laryngeal exposure during laryngoscopy is better in the 25 degrees back-up position than in the supine position. Br J Anaesth. 2007;99:581–586.
3. Lane S, Saunders D, Schofield A, Padmanabhan R, Hildreth A, Laws D. A prospective, randomised controlled trial comparing the efficacy of pre-oxygenation in the 20 degrees head-up vs supine position. Anaesthesia. 2005;60:1064–1067.
4. Levitan RM, Mechem CC, Ochroch EA, Shofer FS, Hollander JE. Head-elevated laryngoscopy position: improving laryngeal exposure during laryngoscopy by increasing head elevation. Ann Emerg Med. 2003;41:322–330.