CHEST Guidelines-Ramped-Position

Ramped-Position_chest

Pdf Summary

The document includes two letters to the editor published in the journal "Chest," both addressing different medical topics.<br /><br />The first letter is a response by Drs. Marilyn G. Foreman and Eric L. Flenaugh to a discussion on pulmonary concierge practices. They agree with Drs. Alrajab and Uysal on the need for basic healthcare coverage for all but emphasize the inadequacy of merely "encouraging" community and charity clinics without proper incentivization. They express concerns about health equity and moral implications if financial barriers are imposed by widespread adoption of concierge practices. While noting progress in healthcare equity, they still advocate caution in broadly implementing concierge practices due to potential disparities they might introduce.<br /><br />The second letter is from Drs. Sarfaraz Navaz Rahiman and Michael Keane regarding the optimal positioning of patients during intubation, responding to a study by Semler et al., which compared ramped and sniffing positions. Rahiman and Keane argue that the ramped position could lead to less effective intubation due to misunderstanding and misapplication of airway positioning techniques. They question the trial's findings and underscore the need for evidence directly relevant to clinical settings, emphasizing that the positioning trial might have led to worse intubation outcomes due to the setup methods used.<br /><br />The response from the original study's authors acknowledges the feedback and agrees with the interpretation that the ramped position resulted in poorer intubation outcomes. They clarify that their study did not redefine the positioning techniques but utilized existing recommendations, which in practice did not yield better results compared to the sniffing position. They recognize the need for more clinically relevant evidence to guide such practices in critical care environments.<br /><br />Overall, both letters highlight ongoing debates and considerations in medical practices related to healthcare access and clinical procedures, emphasizing the importance of ethical considerations and evidence directly applicable to clinical practice.

Keywords

pulmonary concierge practices

healthcare equity

intubation positioning

ramped position

sniffing position

clinical evidence

healthcare access

ethical considerations

community clinics

clinical practice