Abstract
BackgroundThe head-tilt/chin-lift (HT/CL) maneuver is simple and routinely used to open a closed upper airway.ObjectivesIt has yet to be determined whether increasing the HT/CL angle further would be beneficial.MethodsWe enrolled 60 (30 males) 20-year-old conscious participants. Pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were defined as positions in which the angle between the ear–eye line and the horizontal line was 80°, 65°, and 50°, respectively. Peak exploratory flow rates (PEFRs) pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were recorded continuously at 1-minute intervals (one set). Five sets of measurements were performed (total, 15 measurements for each participant).ResultsWe analysed 900 measurements (180 sets). The mean PEFRs pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were 348.4 ± 96.9, 366.4 ± 104.9, and 378.8 ± 111.2 L/min (percentage change compared to pre-HT/CL, 5.2% and 8.7%), respectively. Significant differences were observed among pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions in all participants, as well as in subgroup classified according to sex, and medians of height, body weight, and body mass index.ConclusionOur findings suggest that a greater HT/CL angle would be beneficial, as the PEFR increased gradually. The decreasing manner in the PEFR increase with the HT/CL angle implies the existence of an angle threshold beyond which there were no further benefits in airflow, indicating a minimum in airway resistance. A HT/CL maneuver may be appropriate until locking the atlanto-occipital and cervical spine joints in extension occurs and the chest (sternal notch) begins to rise.
Highlights
The head-tilt/chin-lift (HT/CL) maneuver has long been recommended as a method of opening a closed airway in unconscious patients without head or neck trauma
Significant differences were observed among pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions in all participants, as well as in subgroup classified according to sex, and medians of height, body weight, and body mass index
Our findings suggest that a greater HT/CL angle would be beneficial, as the Peak exploratory flow rates (PEFRs) increased gradually
Summary
The head-tilt/chin-lift (HT/CL) maneuver has long been recommended as a method of opening a closed airway in unconscious patients without head or neck trauma. After a closed airway has opened, it has not been established whether additional angulation would be beneficial (angulation dependency of an opened airway). These questions have yet to be resolved because unconscious patients require immediate emergency management and are not able to be measured or examined for purposes other than those required during such emergencies. The head-tilt/chin-lift (HT/CL) maneuver is simple and routinely used to open a closed upper airway.
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