CHEST Guidelines-Comparing-Ramped-Position-vs-Sniffing-Position-for

Comparing-Ramped-Position-vs-Sniffing-Position-for

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The document discusses two medical studies published in the journal CHEST relating to the treatment of obstructive sleep apnea (OSA) using different devices and positions for endotracheal intubation.<br /><br />The first section addresses the critique concerning the comparison of mandibular advancement devices with Continuous Positive Airway Pressure (CPAP) devices for OSA. Dr. Malcolm Kohler and Dr. Esther I. Schwarz defend the use of network meta-analysis in their research due to the lack of direct comparison trials. They indicate that, although evidence is limited, network analyses still allow effective inferences about treatment efficacy.<br /><br />The document also touches on the ongoing debate regarding treatment for minimally symptomatic OSA patients, noting that many undergo sleep studies due to snoring and observed apneic episodes. Kohler and Schwarz suggest treatment trials should be offered if patients demonstrate substantial sleep-disordered breathing even with minimal symptoms.<br /><br />The second section discusses a randomized controlled trial on intubation, comparing the ramped versus the sniffing position. Drs. Fu-Shan Xue, Hui-Xian Li, and Ya-Yang Liu criticize certain aspects of the study, such as whether optimal bed height was ensured and whether external laryngeal manipulation was used to improve visualization. They also raise concerns about whether operators' experience was appropriately consistent with the techniques used.<br /><br />In response, the study's authors clarify that bed height adjustments and external manipulation were indeed facilitated. They also highlight that operators averaged 60 prior intubations, with comparable experience across groups using specific laryngoscope devices, addressing concerns about operator skill levels.<br /><br />Both discussions emphasize the importance of methodological rigor and nuanced interpretation in medical research on OSA treatment and intubation techniques.

Keywords

obstructive sleep apnea

mandibular advancement devices

Continuous Positive Airway Pressure

network meta-analysis

treatment efficacy

minimally symptomatic OSA

ramped position

sniffing position

intubation techniques

medical research