Cricoid Pressure Does Not Increase the Rate of Failed Intubation by Direct Laryngoscopy in Adults

Turgeon, Alexis F.; Nicole, Pierre; Trépanier, Claude A.; Marcoux, Sylvie; Lessard, Martin

doi:10.1097/00000542-200502000-00012

Cited by 80 publications

(60 citation statements)

References 26 publications

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“…In our elective surgical population, the incidence of failed orotracheal intubation by direct laryngoscopy within 30 sec is 4%. 14 We considered that an increase to 10% in the failure rate would represent a clinically significant difference. Therefore, it was determined that a sample size of 255 patients per group was required to consider Type I and Type II errors of 5 and 20%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The choice of a 30-sec attempt was made a priori because it represents a reasonable duration for a tracheal intubation attempt. [14][15][16] The Advanced Trauma Life Support (ATLS) guidelines state, ''if endotracheal intubation is not accomplished within 30 seconds or in the same time required to hold your breath before exhaling, discontinue attempts…''. 35 Manual in-line stabilization is used in trauma patients, many of whom have associated head injury.…”

Section: Discussionmentioning

confidence: 99%

“…A 30-sec period was permitted to complete endotracheal intubation. [14][15][16] If capnography did not confirm tracheal intubation, the attempt could be resumed only if there was time remaining in this 30-sec period. In both groups, if the patient could not be successfully intubated within 30 sec, the attempt was aborted and recorded as a failure.…”

Section: Methodsmentioning

confidence: 99%

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Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Thiboutot

Nicole

Trépanier

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Although manual in-line stabilization (MILS) is commonly used during endotracheal intubation in patients with either known or suspected cervical spine instability, the effect of MILS on orotracheal intubation is poorly documented. This study evaluated the rate of failed tracheal intubation in a fixed time interval with MILS. Methods Two hundred elective surgical patients were randomized into two groups. In the MILS group, the patient's head was stabilized in a neutral position by grasping the patient's mastoid processes to minimize any head movement during tracheal intubation. In the control group, the patient's head rested in an optimal position for tracheal intubation. A 30-sec period was allowed to complete tracheal intubation with a #3 Macintosh laryngoscope blade. The primary endpoint was the rate of failed tracheal intubation at 30 sec. Secondary endpoints included tracheal intubation time and the Cormack & Lehane grade of laryngoscopy.Results Patient characteristics were similar with respect to demographic data and risk factors for difficult tracheal intubation. The rate of failed tracheal intubation at 30 sec was 50% (47/94) in the MILS group compared to 5.7% (6/ 105) in the control group (P \ 0.0001). Laryngoscopic grades 3 and 4 were more frequently observed in the MILS group. Mean times for successful tracheal intubation were 15.8 ± 8.5 sec and 8.7 ± 4.6 sec for the MILS and control groups, respectively (mean difference 7.1, CI 95% 5.0-9.3, P \ 0.0001). All patients who failed tracheal intubation in the MILS group were successfully intubated when MILS was removed. Conclusion In patients with otherwise normal airways, MILS increases the tracheal intubation failure rate at 30 sec and worsens laryngeal visualization during direct laryngoscopy. RésuméObjectif Bien que la stabilisation manuelle en ligne (SMEL) soit fre´quemment utilise´e pendant l'intubation endotrache´ale chez des patients pre´sentant une instabilited e la colonne cervicale connue ou suspecte´e, l'effet de la SMEL sur l'intubation orotrache´ale est tre`s peu documente´e. Cette e´tude a e´value´le taux d'e´chec de l'intubation trache´ale dans un intervalle de temps fixe avec une SMEL. Méthode Deux cents patients devant subir des chirurgies non urgentes ont e´te´randomise´s en deux groupes. Dans le groupe SMEL, la teˆte du patient a e´te´stabilise´e dans une

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Thiboutot

Nicole

Trépanier

et al. 2009

Can J Anesth/J Can Anesth

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“…A manobra de BURP (backward, upward, rightward pressure on the thyroid cartilage) tem sido considerada uma opção interessante para esses casos 33 , mas não deve ser confundida com a descrita por Sellick 2 . Os efeitos da compressão na cartilagem cricóide na laringoscopia foram avaliados por diferentes autores e os resultados foram conflitantes [34][35][36] . Uma provável explicação para a diferença nos resultados observados é a variação anatô-mica das vias aéreas entre os indivíduos avaliados.…”

Section: Manobra De Sellick E a Laringoscopiaunclassified

“…The BURP maneuver (backward, upward, rightward pressure on the thyroid cartilage) has been considered an interesting option in those cases 33 , but it should not be mistaken for the maneuver described by Sellick 2 . The effects on brochoscopy of applying pressure on the cricoid cartilage were evaluated by different authors, with conflicting results [34][35][36] . Anatomical variation of the airways among the individuals evaluated might explain the different results.…”

Section: Sellick Maneuver and Laryngoscopymentioning

confidence: 99%

Compressão da cartilagem cricóide: aspectos atuais

Moro¹,

Goulart²

2008

Rev. Bras. Anestesiol.

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Rev Bras AnestesiolARTIGO DE REVISÃO 2008; 58: 6: 643-650 REVIEW ARTICLE RESUMO Moro ET, Goulart A -Compressão da Cartilagem Cricóide. Aspectos Atuais. JUSTIFICATIVA E OBJETIVOS:Sellick descreveu a importância da pressão aplicada na cartilagem cricóide para a prevenção da regurgitação do conteúdo gástrico durante a indução da anestesia. Desde então a manobra tem sido universalmente aceita pelos anestesiologistas como um passo fundamental durante a indução com a técnica de seqüência rápida. O presente artigo teve como objetivo discutir as indicações, a técnica, as complicações e os motivos pelos quais alguns autores têm contestado a eficácia dessa técnica. CONTEÚDO:Foram revisadas as indicações, a técnica e as complicações da manobra de compressão da cartilagem cricóide. Também foram discutidos os aspectos que têm motivado alguns autores a abandonar a manobra de Sellick durante a indução anestésica com a técnica de seqüência rápida. CONCLUSÕES:A aplicação da manobra de compressão da cartilagem cricóide exige o conhecimento da anatomia da via aérea superior e da força correta a ser empregada. Estudos endoscópicos e radiológicos, assim como pacientes que apresentaram aspiração pulmonar a despeito da aplicação da manobra de Sellick, têm colocado em questão a utilidade da técnica. Além disso, quando mal empregada, pode causar deformidade dessa cartilagem, fechamento das cordas vocais e dificuldade de ventilação. Apesar do papel de destaque representado pela manobra de Sellick na prevenção da aspiração pulmonar, não há garantia de proteção das vias aéreas para todos os pacientes, sobretudo quando a técnica não é corretamente aplicada.

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Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia

et al. 2019

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The use of cricoid pressure (Sellick maneuver) during rapid sequence induction (RSI) of anesthesia remains controversial in the absence of a large randomized trial.OBJECTIVE To test the hypothesis that the incidence of pulmonary aspiration is not increased when cricoid pressure is not performed.DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, noninferiority trial conducted in 10 academic centers. Patients undergoing anesthesia with RSI were enrolled from February 2014 until February 2017 and followed up for 28 days or until hospital discharge (last follow-up, February 8, 2017). INTERVENTIONSPatients were assigned to a cricoid pressure (Sellick group) or a sham procedure group.MAIN OUTCOMES AND MEASURES Primary end point was the incidence of pulmonary aspiration (at the glottis level during laryngoscopy or by tracheal aspiration after intubation). It was hypothesized that the sham procedure would not be inferior to the cricoid pressure. The secondary end points were related to pulmonary aspiration, difficult tracheal intubation, and traumatic complications owing to the tracheal intubation or cricoid pressure. RESULTSOf 3472 patients randomized, mean (SD) age was 51 (19) years and 1777 (51%) were men. The primary end point, pulmonary aspiration, occurred in 10 patients (0.6%) in the Sellick group and in 9 patients (0.5%) in the sham group. The upper limit of the 1-sided 95% CI of relative risk was 2.00, exceeding 1.50, failing to demonstrate noninferiority (P = .14). The risk difference was −0.06% (2-sided 95% CI, −0.57 to 0.42) in the intent-to-treat population and −0.06% (2-sided 95% CI, −0.56 to 0.43) in the per protocol population. Secondary end points were not significantly different among the 2 groups (pneumonia, length of stay, and mortality), although the comparison of the Cormack and Lehane grade (Grades 3 and 4, 10% vs 5%; P <.001) and the longer intubation time (Intubation time >30 seconds, 47% vs 40%; P <.001) suggest an increased difficulty of tracheal intubation in the Sellick group.CONCLUSIONS AND RELEVANCE This large randomized clinical trial performed in patients undergoing anesthesia with RSI failed to demonstrate the noninferiority of the sham procedure in preventing pulmonary aspiration. Further studies are required in pregnant women and outside the operating room.

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Cricoid Pressure Does Not Increase the Rate of Failed Intubation by Direct Laryngoscopy in Adults

Abstract: CP applied by trained personnel does not increase the rate of failed intubation. Hence CP should not be avoided for fear of increasing the difficulty of intubation when its use is indicated.

Cited by 80 publications

References 26 publications

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Compressão da cartilagem cricóide: aspectos atuais

Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia

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