From the Department of Anaesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Maribor, Slovenia.
Faculty of Medicine, University of Maribor, Maribor, Slovenia.
Anesth Analg. 2021 Jan;132(1):261-267. doi: 10.1213/ANE.0000000000004360.
Application of cricoid pressure (CP) during rapid sequence induction and intubation sequence has been a "standard" of care for many decades, despite limited scientific proof of its efficacy in preventing pulmonary aspiration of gastric contents. While some of the current rapid sequence induction and intubation guidelines recommend its use, other international guidelines do not, and many clinicians argue that there is insufficient evidence to either continue or abandon its use. Recently published articles and accompanying editorials have reignited the debate on the efficacy and safety of CP application and have generated multiple responses that pointed out the various (and significant) limitations of the available evidence. Thus, a critical discussion of available data must be undertaken before making a final clinical decision on such an important patient safety issue. In this review, the authors will take an objective look at the available scientific evidence about the effectiveness and safety of CP in patients at risk of pulmonary aspiration of gastric contents. We suggest that current data are inadequate to impose clinical guidelines on the use of CP because we acknowledge that currently there is not, and there may never be, a method to prevent aspiration in all patients. In addition, we reiterate that a universally accepted medical-legal standard for approaching the high-risk aspiration patient does not exist, discuss the differences in practice between the US and international practitioners regarding use of CP, and propose 5 recommendations on how future studies might be designed to obtain optimal scientific evidence about the effectiveness and safety of CP in patients at risk for pulmonary aspiration.
环状软骨施压（CP）在快速序贯诱导和插管序列中的应用已经是几十年的“标准”护理措施，尽管其在预防胃内容物误吸方面的功效的科学证据有限。尽管一些当前的快速序贯诱导和插管指南建议使用 CP，但其他国际指南不建议使用，许多临床医生认为，没有足够的证据来继续或放弃使用 CP。最近发表的文章和相关社论重新引发了关于 CP 应用的功效和安全性的辩论，并产生了多个回应，指出了现有证据的各种（重大）局限性。因此，在就如此重要的患者安全问题做出最终临床决策之前，必须对现有数据进行批判性讨论。在这篇综述中，作者将客观地审视有关 CP 在有胃内容物误吸风险的患者中的有效性和安全性的现有科学证据。我们认为，目前的数据不足以对 CP 的使用施加临床指南，因为我们承认，目前没有，而且可能永远不会有，一种方法可以预防所有患者的误吸。此外，我们重申，对于高风险误吸患者，目前没有一个普遍接受的医学法律标准，讨论了美国和国际从业者在使用 CP 方面的实践差异，并提出了 5 条关于如何设计未来研究以获得关于 CP 在有肺误吸风险的患者中的有效性和安全性的最佳科学证据的建议。
