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Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomised controlled trial
- Source :
- Trials, Vol 13, Iss 1, p 17 (2012), Trials
- Publisher :
- Springer Nature
-
Abstract
- Background Cricoid pressure is considered to be the gold standard means of preventing aspiration of gastric content during Rapid Sequence Intubation (RSI). Its effectiveness has only been demonstrated in cadaveric studies and case reports. No randomised controlled trials comparing the incidence of gastric aspiration following emergent RSI, with or without cricoid pressure, have been performed. If improperly applied, cricoid pressure increases risk to the patient. The clinical significance of aspiration in the emergency department is unknown. This randomised controlled trial aims to; 1. Compare the application of the 'ideal" amount of force (30 - 40 newtons) to standard, unmeasured cricoid pressure and 2. Determine the incidence of clinically defined aspiration syndromes following RSI using a fibrinogen degradation assay previously described. Methods/design 212 patients requiring emergency intubation will be randomly allocated to either control (unmeasured cricoid pressure) or intervention groups (30 - 40 newtons cricoid pressure). The primary outcome is the rate of aspiration of gastric contents (determined by pepsin detection in the oropharyngeal/tracheal aspirates or treatment for aspiration pneumonitis up to 28 days post-intubation). Secondary outcomes are; correlation between aspiration and lowest pre-intubation Glasgow Coma Score, the relationship between detection of pepsin in trachea and development of aspiration syndromes, complications associated with intubation and grade of the view on direct largyngoscopy. Discussion The benefits and risks of cricoid pressure application will be scrutinised by comparison of the incidence of aspiration and difficult or failed intubations in each group. The role of cricoid pressure in RSI in the emergency department and the use of a pepsin detection as a predictor of clinical aspiration will be evaluated. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611000587909
- Subjects :
- medicine.medical_specialty
Rapid Sequence Intubation (RSI)
Time Factors
medicine.medical_treatment
Medicine (miscellaneous)
Aspiration pneumonia
Aspiration Pneumonitis
Pneumonia, Aspiration
law.invention
Cricoid Cartilage
Study Protocol
Randomized controlled trial
law
Cricoid cartilage
medicine
Intubation, Intratracheal
Pressure
Intubation
Humans
Pharmacology (medical)
Prospective Studies
Cricoid pressure
pepsin
lcsh:R5-920
aspiration
business.industry
Respiratory Aspiration
Emergency department
respiratory system
medicine.disease
Pepsin A
Surgery
medicine.anatomical_structure
Treatment Outcome
Research Design
cricoid pressure
New South Wales
business
Emergency Service, Hospital
lcsh:Medicine (General)
Biomarkers
Subjects
Details
- Language :
- English
- ISSN :
- 17456215
- Volume :
- 13
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Trials
- Accession number :
- edsair.doi.dedup.....a4aded014b20ff57ab597d14b04f40e0
- Full Text :
- https://doi.org/10.1186/1745-6215-13-17