NCT04410289

Defining the 'Sniffing Position" in Infants and Toddlers - A Pilot Study

A Prospective Randomized Pilot Study to Define and Validate the Standard 'Sniffing Position' in Infants and Toddlers.

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 40 (actual)
• Sponsor: Tufts Medical Center · Academic / Other
• Sex: All
• Age: 1 Month – 48 Months
• Healthy volunteers: Not accepted

Summary

The "sniffing position" is widely accepted as a favorable position for direct laryngoscopy (DL) in both pediatric and adult patients. External anatomical markers are well documented to confirm proper 'sniffing position' in adults, but data on their use in the pediatric population is sparse. The investigators propose to define these markers in young children and investigate whether patients positioned using this standardized approach have better intubating conditions than those positioned randomly per the preference of the anesthesiologist.

Detailed description

The procedure of endotracheal intubation in adults and children is a continuum, and begins with proper head positioning prior to direct laryngoscopy (DL). It is an accepted paradigm that proper positioning optimizes intubating conditions, and decreases subsequent airway maneuvers and manipulation. The sniffing position is an accepted airway positioning concept in pediatric airway management, and continues to be recommended by experts and textbooks in the field. Anatomical peculiarities such as the large head relative to the torso in infants and toddlers is assumed to put the head in proper position when gently extended. However, reproducible parameters to confirm optimal head positioning remain vague and unclear. In the absence of objective and measurable markers, practitioners position infants and toddlers according to their individual preferences, and as such the procedure lacks definition and objective clarity. The investigators plan to recruit 40 healthy patients between the ages of 1 month - 48 months and randomize them to be positioned either according to a predetermined algorithm or positioned freely according to the provider's preference. Patients randomized to the intervention group will be positioned with the aim to horizontally align the external auditory meatus (EAM) with the sternal notch (SN). In summary, the study aims to define the sniffing position for infants and toddlers using reproducible objective secondary markers, and investigate whether a systematic approach to positioning using such markers improves direct laryngoscopic outcomes in the young pediatric patient population.

Conditions

• Airway Management
• Infant ALL
• Children, Only
• Endotracheal Intubation

Interventions

Type	Name	Description
PROCEDURE	Airway positioning per specified protocol followed by Direct Laryngoscopy and Endotracheal Intubation	Positioning of the patient's head and neck for the purpose of direct laryngoscopy and endotracheal intubation
PROCEDURE	Airway positioning per provider preference followed by Direct Laryngoscopy and Endotracheal Intubation	Positioning of the patient's head and neck for the purpose of direct laryngoscopy and endotracheal intubation

Timeline

• Start date: 2019-07-01
• Primary completion: 2019-11-30
• Completion: 2019-12-26
• First posted: 2020-06-01
• Last updated: 2020-06-04

Locations

1 site across 1 country: United States