To date the study that has shown the biggest benefit to HOB elevation is the 2016 study performed by Khandelwal and colleagues in a teaching hospital system in Seattle, WA.

528 patients managed by anesthesiologists outside of the operating room (ICU, floor) were randomized to Back up, Head elevated to 30 degrees vs supine. Any intubation performed at a HOB angle of <30 degrees was determined to be supine, so there could have been some 20 degree HOB elevation intubations performed. This dilutes the difference between HOB elevation vs supine results as 20 degree HOB elevation is not supine. The authors assessed for 1 or more airway complications: difficult intubation with >3 looks, or >10min tube placement, esophageal intubation, hypoxia <90%, or aspiration.

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