Which Is the Original and Which Is the Modified Rapid Sequence Induction and Intubation? Let History Be the Judge!

Salem, M. Ramez; Clark-Wronski, Julianna Myriad; Khorasani, Arjang; Crystal, George J.

doi:10.1213/ane.0b013e31827696fa

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…11,12,29,30 However, previous studies that have evaluated aspiration during bag-mask ventilation have been limited to the examination of anesthetized healthy volunteers, have used epigastric auscultation to detect gastric insufflation as a surrogate for aspiration, and have reported conflicting results. 14,31–36 Given the low incidence of operator-reported aspiration during tracheal intubation of critically ill adults, 7,37,38 determining whether bag-mask ventilation increases the relative risk of aspiration by 50% would require a trial enrolling approximately 4000 patients. However, our trial provides some reassurance, since the incidence of operator-reported aspiration was numerically lower in the bag-mask ventilation group than in the no-ventilation group.…”

Section: Discussionmentioning

confidence: 99%

“…11 Whether providing positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during this interval prevents hypoxemia without increasing the risk of gastric or oropharyngeal aspiration has been debated for nearly 50 years. 12–14 Some guidelines recommend providing bag-mask ventilation between induction and laryngoscopy to all patients, including those who are not initially hypoxemic. 12,15–17 Other guidelines recommend avoiding bag-mask ventilation between induction and laryngoscopy except to treat hypoxemia, a recommendation that prioritizes the perceived risk of aspiration over the potential benefits of preventing hypoxemia.…”

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confidence: 99%

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Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults

2019

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BACKGROUND Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial. METHODS In a multicenter, randomized trial conducted in seven intensive care units in the United States, we randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy. The primary outcome was the lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation. The secondary outcome was the incidence of severe hypoxemia, defined as an oxygen saturation of less than 80%. RESULTS Among the 401 patients enrolled, the median lowest oxygen saturation was 96% (interquartile range, 87 to 99) in the bag-mask ventilation group and 93% (interquartile range, 81 to 99) in the no-ventilation group (P = 0.01). A total of 21 patients (10.9%) in the bag-mask ventilation group had severe hypoxemia, as compared with 45 patients (22.8%) in the no-ventilation group (relative risk, 0.48; 95% confidence interval [CI], 0.30 to 0.77). Operator-reported aspiration occurred during 2.5% of intubations in the bag-mask ventilation group and during 4.0% in the no-ventilation group (P = 0.41). The incidence of new opacity on chest radiography in the 48 hours after tracheal intubation was 16.4% and 14.8%, respectively (P = 0.73). CONCLUSIONS Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation. (Funded by Vanderbilt Institute for Clinical and Translational Research and others; PreVent ClinicalTrials.gov number, NCT03026322.)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults

2019

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“…44 Seeing complexity of the situation, researches have recommended that in patients with difficult airway who is at high risk of aspiration, awake intubation is advisable. 43,45…”

Section: Supraglottic Airway Devices and Cpmentioning

confidence: 99%

Cricoid pressure controversies

Kaur

Pareek

Harsh

et al. 2020

Int J Community Med Public Health

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Rapid sequence induction (RSI) is a common technique used in clinical anaesthesia to prevent pulmonary aspiration of gastric contents. Sellick introduced this in 1961. However, scientific validation to show the advantage of this technique in preventing aspiration is limited in literature. Numerous researches have shown that cricoid pressure (CP) application might have no benefit in preventing aspiration. Additionally this could lead to problems in securing the airway. Proper teaching and regular training sessions of this technique are mandatory in routine anaesthesia practice.

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“…Primary purpose of intubation in TBI (unless the patient is severely hypoxic) is to secure & protect the airway and is usually can be planned with proper preoxygenation and preparation to prevent the physiological disturbances during airway manipulation. Most of these patients are intubated using Rapid Sequence Intubation (RSI) technique which involves administration of sedative agent and rapidly acting paralysing agent in quick succession to facilitate placement of endotracheal tube and is considered the standard approach for airway management in patients with trauma [7][8][9]. Primary purpose of RSI is to secure the airway as soon as possible with minimal risk of aspiration as all trauma patients are presumed to have full stomach.…”

Section: Introductionmentioning

confidence: 99%

“…Primary purpose of RSI is to secure the airway as soon as possible with minimal risk of aspiration as all trauma patients are presumed to have full stomach. RSI is considered the standard approach for airway management in patients with trauma [7][8][9]. Protection and immobilization of cervical spine (C spine) is essential in all trauma patients with altered level of consciousness.…”

Section: Introductionmentioning

confidence: 99%

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Which Is the Original and Which Is the Modified Rapid Sequence Induction and Intubation? Let History Be the Judge!

Cited by 9 publications

References 8 publications

Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults

Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults

Cricoid pressure controversies

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