Parry Andrew
University Hospital of Wales, Cardiff, UK.
Nurs Crit Care. 2009 May-Jun;14(3):139-44. doi: 10.1111/j.1478-5153.2009.00326.x.
This literature review explores the role of force and education in cricoid pressure, an essential aspect of practice for any nurse within a critical care environment.
Cricoid pressure is utilized in everyday practice during rapid sequence induction (RSI) of anaesthesia. The purpose of cricoid pressure is to occlude the oesophagus in order to reduce the risk of acid aspiration during emergency induction of anaesthesia. The importance of best practice cannot be overstated because of high rates of mortality following acid aspiration.
Literature searches were conducted using the key words cricoid pressure, Sellick manoeuvre, rapid sequence induction and acid aspiration syndrome. Articles were obtained from online searches, with literature published in the last 10 years being used; some seminal literature and textbooks were incorporated for definition purposes.
The literature displayed a disparity in practice and differing opinions on the optimal force to occlude the oesophagus. The role of education in correct application of cricoid pressure was explored, with unanimous conclusions that education plays a role in ensuring best practice.
Forces of 20-30 N are adequate to occlude the oesophagus and minimize the risk of acid aspiration. However, it is difficult for practitioners to accurately estimate this force in everyday practice. Various methods of assessing force were discussed, with the use of a 50-mL syringe suggested as a cost-effective and simple method to utilize in practice.
The literature review demonstrated that the subject of cricoid pressure is relevant in critical care practice in order to ensure patient safety during RSI. Thus, all critical care nurses have a duty to gain a working knowledge on the subject if patient safety is to be maintained. This paper provides a source of information on cricoid pressure and realistic methods of maintaining best practice.
本综述探讨了力量和教育在环状软骨压迫中的作用，这是重症监护环境中任何护士实践的重要方面。
环状软骨压迫在麻醉快速顺序诱导（RSI）的日常实践中被使用。环状软骨压迫的目的是阻塞食管，以降低麻醉紧急诱导期间胃酸误吸的风险。由于胃酸误吸后的高死亡率，最佳实践的重要性再怎么强调也不为过。
使用关键词环状软骨压迫、Sellick手法、快速顺序诱导和胃酸误吸综合征进行文献检索。文章通过在线搜索获得，使用的是过去10年发表的文献；为了定义目的纳入了一些经典文献和教科书。
文献显示在实践中存在差异，对于阻塞食管的最佳力量也有不同意见。探讨了教育在正确应用环状软骨压迫中的作用，一致得出结论认为教育在确保最佳实践中发挥作用。
20 - 30牛的力量足以阻塞食管并将胃酸误吸的风险降至最低。然而，在日常实践中，从业者很难准确估计这种力量。讨论了各种评估力量的方法，建议使用50毫升注射器作为一种经济有效且简单的实践方法。
文献综述表明，环状软骨压迫这一主题在重症监护实践中与确保RSI期间的患者安全相关。因此，如果要维护患者安全，所有重症监护护士都有责任掌握该主题的实用知识。本文提供了有关环状软骨压迫的信息来源以及维持最佳实践的切实可行方法。
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