Cricoid Pressure For Pediatric Intubation

Written by Thomas Davis

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Use of cricoid pressure did not decrease the risk of regurgitation during pediatric tracheal intubation.

Why does this matter?
Use of cricoid pressure has long been promoted as a standard of care to decrease the risk of regurgitation and tracheal aspiration during intubation. However, cricoid pressure is hard to apply correctly. Cricoid pressure often causes lateral displacement of the esophagus rather than compression. Laryngoscopy then applies counter pressure negating the effectiveness of even correctly applied cricoid pressure. Is there any evidence that cricoid pressure is effective?

Intubation is a no pressure situation.
Tracheal intubations were prospectively recorded in a database for 35 multinational PICUs. Among the 7,825 direct laryngoscopy intubations, 23% (n=1819) used cricoid pressure. There were 106 regurgitation occurrences. After multivariable adjustment, cricoid pressure had a trend towards increased regurgitation but was not statistically significant (adjusted OR, 1.57; 95% CI, 0.99—2.47; p=0.054). Propensity score matching of 1,194 matched pairs found no clinically meaningful increase in regurgitation with cricoid pressure (adjusted OR, 1.01; p=0.036). While the study is limited by risk for reporting bias and the possibility that cricoid pressure was not performed correctly by non-anesthesiologists, it provides further evidence that cricoid pressure does not offer benefit to clinical practice.

Source
Cricoid Pressure During Induction for Tracheal Intubation in Critically Ill Children: A Report From National Emergency Airway Registry for Children.  Pediatr Crit Care Med. 2018 Jun;19(6):528-537. doi: 10.1097/PCC.0000000000001531.
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Reviewed by Clay Smith

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