The determination of an effective cricoid pressure

Abstract

A study of cricoid pressure was undertaken to relate the applied cricoid force with the resulting intraluminal cricopharyngeal (or oesophageal) pressure. The results indicate that whilst there was a wide range in normal adults a cricoid force of 44 N was judged to be effective in protecting the majority of adult patients from regurgitation.

Practice makes perfect? Evaluation of cricoid pressure task training for use within the algorithm for rapid sequence induction in critical care

“…It has been demonstrated that the upper oesophagus can be occluded by the correct application of cricoid force at or in excess of 30 newtons (N). [14][15][16] Wraight et al extrapolated from his research that a force of 44 N would suffice for instances of above average intragastric pressure. 14 Force in excess of 44 N carries an increased risk of airway obstruction, which becomes significant should there be a failure to intubate.…”

“…[14][15][16] Wraight et al extrapolated from his research that a force of 44 N would suffice for instances of above average intragastric pressure. 14 Force in excess of 44 N carries an increased risk of airway obstruction, which becomes significant should there be a failure to intubate. This level of force might directly impede intubation and is implicated in some case reports of soft tissue injury.…”

Cricoid pressure: Where do we stand?

“…This force was recommended by Wraight et al . [18] as a cricoid force that would prevent regurgitation with a theoretical maximum gastric pressure of 59 mm of Hg in 50% of patients. However, it has been found that excessive force, especially > 40N, can compromise airway patency and cause difficulty with tracheal intubation.…”

“…[19] Wraight et al . [18] have shown that 34N occluded a manometry catheter behind the cricoid cartilage at pressure >30 mm of Hg in all patients. In another study, by Vanner et al .,[20] cricoid force of 30N occluded the manometry catheter with a pressure >25 mm of Hg in all patients.…”

Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomised controlled trial

“…The amount of force used by the cricoid operator is a crucial factor in proper application of CP. A force in the range of 30 - 40 Newtons (N) applied to the cricoid ring is generally accepted as sufficient to occlude the oesophagus [5,12,16-18], preventing regurgitation of gastric contents. Studies have revealed that the knowledge of cricoid force theory and concept of the forces required is poor amongst both anaesthetic and ED staff [19-31].…”