Methodology Score: 3.5/5               
Usefulness Score: 3/5

Semler MW, et al. Chest. 2017 Oct;152(4):712-722.

Should the Ramped Position Be “Sniffed at” in the ICU?
Scott JA, et al. Chest. 2017 Oct;152(4):693-694.

Question and Methods: Multicenter, randomized, unblinded, trial of 260 ICU patients comparing the ramped vs sniffing position for intubations performed by critical care fellows.

Findings: There were no differences in the primary outcome of lowest SpO2 and the secondary outcome of rates of hypoxemia.  The ramped position was associated with worsened glottic view and increased number of laryngoscopy attempts.

Limitations and Interpretation: This study challenges the results of previous operating room studies and casts doubt on the idea of the ramped position being better for all intubations.  The results, however, cannot speak to the previously demonstrated and intuitive benefits of the ramped position for obese patients.

By: Dr. Bo Zheng

Epi lesson

Difference between the groups used for sample size calculation in RCTs
When evaluating sample size calculation for a randomized controlled trial, a key step is to determine if the difference between the two study arms that is used for sample size calculation is clinically important one. Powering a study based on a difference that has no clinically significance will have no practice implication.
By: Dr. Venkatesh Thiruganasambandamoorthy


  • Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.