Prior studies have suggested that patients should be intubated emergently in an upright, head-forward position rather than in the traditional supine position. This is especially true for intubations of morbidly obese patients where it is known that pre-oxygenation and intubation in the semi-upright position (head of bed elevated to 30-45 degrees) is superior to the supine position. For morbidly obese patients with an average BMI ~55, studies show that pre-oxygenation and intubatin in the semi-upright position vs the supine position leads to a 60 second longer the safe apnea period and a two minute shorter recovery time. The safe apnea period is the time before the SpO2 drops below 90% and the recovery time is the time to oxygenate greater than 90% via bag-mask ventilation once desaturation occurs.
In this current study, 231 intubations performed in two emergency departments (EDs) by 58 residents affiliated with a single residency program were analyzed. Patient positioning was chosen at convenience and the angle of elevation of the bed was measured. First-attempt success was attained in 66% of supine intubations, 78% of inclined intubations, and 86% of upright intubations (angle of bed, ≥45 degrees).