Teaching anaesthetic nurses optimal force for effective cricoid pressure: a literature review

Abstract

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.

Initial management of cardiac arrest in pregnant women

“…Le seul geste qui pourrait réduire ce risque serait de réaliser dès la ventilation au masque une manoeuvre de Sellick [12]. Néanmoins, ce geste n'est pas recommandé, car pour être efficace, il faudrait que les secouristes reçoivent un enseignement spécifique [13]. De plus, il peut aisément gêner la ventilation [6,14].…”

A cricoid cartilage compression device for the accurate and reproducible application of cricoid pressure

“…It involves the application of backward pressure on the cricoid cartilage with a force of between 30 and 40 N [1][2][3][4][5] in order to occlude the upper oesophagus (although latterly it has been suggested that a force of 20-30 N [6][7][8] might be more appropriate). Failure to secure the airway in this way may put the patient at risk of developing aspiration pneumonitis, bacterial pneumonia and or bronchial blockage [9].…”

“…Although ubiquitous, numerous studies have shown that knowledge and skills of cricoid pressure amongst anaesthetic and emergency department staff are still quite poor [8][9][10][28][29][30][31][32]. The main deficiencies lie in the practitioners' method of application and understanding of the correct amount of force to apply [8,30].…”

“…The main deficiencies lie in the practitioners' method of application and understanding of the correct amount of force to apply [8,30]. However, to which anatomical structure the force should be applied also remains an issue [10,29].…”

“…However, to which anatomical structure the force should be applied also remains an issue [10,29]. Efforts to rectify these paucities in proficiency consistently endorse the use of simulators [8,28,[31][32][33][34], but reinforcement through practice needs to be regularly implemented in order that skills remain current [28,32]. If use of this technique is to continue, there appears to be a very urgent need to standardise the method taught, and, perhaps more importantly, the amount of force required in order to prevent aspiration [10].…”