Upright (45°) Versus Supine Position for Intubation in Intracranial Bleed Patients

Objective: To find out the effective method of endotracheal intubation among patients of intracranial bleed.

Methods: A quasi experimental research was performed at emergency department of Ziauddin University Hospital Karachi. 236 intracranial bleed patients were selected by consecutive sampling, half of them were intubated at upright position (45°) and remaining half at supine position. Patients of musculoskeletal deformities, ischemic stroke and previously intubated were excluded. Success or failure of endotracheal tube was confirmed by measuring oxygen saturation and audible breath sounds on chest.

Results: Success rate of endotracheal placement (p-value <0.001) was high in upright position 115 (97.5%) as compared to supine position 90 (76.3%). Similarly, endotracheal tube placement attempts (p-value <0.001) and completion time (p-value <0.001) was low in upright position 1.1 ± 0.4 and 62.9 ± 24.9 sec as compared to supine position 1.5 ± 0.9 and 90.2 ± 67.9 sec.

Conclusion: Endotracheal intubation of intracranial bleed patient at upright position is more successful, effective, less painful in terms of number of attempts and less time consuming as compared to supine position.