Lying supine/on back when unconscious / with reduced level of consciousness / in coma /not awake, may this result in loss of (patient) airway or lead to hypoxia and /or hyperventilation?

Given an existing spinal (cord) injury, will changing the patient’s position from supine to lateral (as in lateral/recovery position or log roll) worsen the spinal injury?

See full search strategy in PROSPERO.

All studies with a controlled comparison.

Basic airway management in unconscious trauma patients.

For question 1: All patients who are unconscious / with reduced level of consciousness lying supine.

For question 2: All patients / cadavers with an unstable cervical spine fracture who are moved from supine to lateral position.

For question 1: Lateral position

For question 2: angulation, rotation or translation between the c-spine above and below the fracture

Question 1: Supine position

Question 2: No angulation, rotation or translation between the c-spine above and below the fracture.

Any.

Primary outcomes

Question 1: Oxygen desaturation. Hyperkapnia

Question 2: Secondary detoriation in spinal cord injury. Movement in the c-spine fracture.

Secondary outcomes

Question 1: Apnea (hypoventilation) index (AI / AHI). Increased upper airway resistance.

1. After search completed all titles and abstracts will be reviewed by two independent reviewers; the principal investigator will review all, which totals six pairs (seven investigators). Discrepancies will be solved by discussion between the two reviewers; if not solved a third independent reviewer will be asked.

2. The full text articles included in step 1 will be reviewed in similar fashion.

3. All included (and some important excluded) articles will be reviewed regarding relevant references which will be entered through step 1.

4. Remaining articles will be evaluated regarding risk of bias using Cochrane Risk of Bias Tool, each outcome evaluated separately if appropriate. RevMan software will be used.

5. GRADE methodology will be used for other evaluation, using GradePro software.

From each study we will extract: Author(s), publication year, journal, study type, context, no. of patients, patient details, intervention type and comparison, outcome parameters as described.

We will be using Cochrane Risk of Bias Tool, each outcome evaluated separately if appropriate. RevMan software will be used.

Data will be aggregated for quantitative synthesises if possible, using RevMan and random effect models.

If applicable subgroup analysis dead vs alive, adults vs children.

The systematic review will be sought published in international, peer-reviewed medical journal.

Per Kristian Hyldmo

Sorlandet Hospital

Postboks 416

4604 Kristiansand

NORWAY

pkh@sshf.no

Norwegian Air Ambulance Foundation

www.norskluftambulanse.no

Dr Per Kristian Hyldmo, Norwegian Air Ambulance Foundation
Dr Gunn E. Vist, Norwegian Knowledge Center for the Health Services
Professor Eldar Søreide, University of Bergen, Norway
Professor Mårten Sandberg, University of Oslo, Norway
Dr Leif Kåre Rognås, University of Århus, Denmark
Dr Vidar Magnusson, Emergency Medical Services, University Hospital of Reykjavik, Iceland
Dr Anders Chr. Feyling, Sorlandet Hospital Kristiansand, Norway

13 February 2012

01 February 2013

The review is part of PhD project. The principal investigator (PKH) is employed (50%) by the Norwegian Air Ambulance Foundation. The other investigators do this as part of their employment in their universities / organizations.

Intellectual conflict of interest: PKH developed the LTP method, no economical interest. The other authors declare no conflict of interest.

English

Norway

Subject indexing assigned by CRD

Airway Management; Humans; Patient Positioning; Patient Safety; Wounds and Injuries

19 September 2012

19 September 2012