What steps are taken to protect against regurgitation during rapid sequence intubation (RSI)?

Updated: Apr 07, 2020
  • Author: Keith A Lafferty, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Though clinical dogma dictates that the Sellick maneuver (firm pressure over the cricoid cartilage to compress the proximal esophagus) be initiated to prevent regurgitation of gastric contents, literature is lacking in support of this technique and in fact may impede laryngeal view.

Initiate this maneuver upon observing the beginning of unconsciousness.

Maintain pressure throughout intubation sequence until the position of the ET tube is verified. Note that proper laryngeal view has been shown to be best accomplished by the bimanual method and should be used if the Sellick maneuver fails to show the vocal cords.

Classical teaching dictates that cricoid pressure decreases the risk of gastric regurgitation into the lungs. However, in a study by Smith et al, the esophagus was partially lateral to the trachea in more than 50% of the subjects. [48] Also, in an ultrasound study, 29 of 33 esophagi were partially displaced to the left of the trachea. [49] In a meta-analysis, Butler and Sen showed that little evidence supports the notion that cricoid pressure decreases the risk of aspiration in RSI. [9]


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