Skip to main content

Cricoid Pressure During Induction for Tracheal Intubation in Critically Ill Children: A Report From National Emergency Airway Registry for Children.

Publication ,  Journal Article
Kojima, T; Harwayne-Gidansky, I; Shenoi, AN; Owen, EB; Napolitano, N; Rehder, KJ; Adu-Darko, MA; Nett, ST; Spear, D; Meyer, K; Giuliano, JS ...
Published in: Pediatr Crit Care Med
June 2018

OBJECTIVES: Cricoid pressure is often used to prevent regurgitation during induction and mask ventilation prior to high-risk tracheal intubation in critically ill children. Clinical data in children showing benefit are limited. Our objective was to evaluate the association between cricoid pressure use and the occurrence of regurgitation during tracheal intubation for critically ill children in PICU. DESIGN: A retrospective cohort study of a multicenter pediatric airway quality improvement registry. SETTINGS: Thirty-five PICUs within general and children's hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). PATIENTS: Children (< 18 yr) with initial tracheal intubation using direct laryngoscopy in PICUs between July 2010 and December 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Multivariable logistic regression analysis was used to evaluate the association between cricoid pressure use and the occurrence of regurgitation while adjusting for underlying differences in patient and clinical care factors. Of 7,825 events, cricoid pressure was used in 1,819 (23%). Regurgitation was reported in 106 of 7,825 (1.4%) and clinical aspiration in 51 of 7,825 (0.7%). Regurgitation was reported in 35 of 1,819 (1.9%) with cricoid pressure, and 71 of 6,006 (1.2%) without cricoid pressure (unadjusted odds ratio, 1.64; 95% CI, 1.09-2.47; p = 0.018). On multivariable analysis, cricoid pressure was not associated with the occurrence of regurgitation after adjusting for patient, practice, and known regurgitation risk factors (adjusted odds ratio, 1.57; 95% CI, 0.99-2.47; p = 0.054). A sensitivity analysis in propensity score-matched cohorts showed cricoid pressure was associated with a higher regurgitation rate (adjusted odds ratio, 1.01; 95% CI, 1.00-1.02; p = 0.036). CONCLUSIONS: Cricoid pressure during induction and mask ventilation before tracheal intubation in the current ICU practice was not associated with a lower regurgitation rate after adjusting for previously reported confounders. Further studies are needed to determine whether cricoid pressure for specific indication with proper maneuver would be effective in reducing regurgitation events.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Pediatr Crit Care Med

DOI

ISSN

1529-7535

Publication Date

June 2018

Volume

19

Issue

6

Start / End Page

528 / 537

Location

United States

Related Subject Headings

  • United States
  • Singapore
  • Retrospective Studies
  • Registries
  • Quality Improvement
  • Propensity Score
  • Pressure
  • Pediatrics
  • New Zealand
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Kojima, T., Harwayne-Gidansky, I., Shenoi, A. N., Owen, E. B., Napolitano, N., Rehder, K. J., … National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI), . (2018). Cricoid Pressure During Induction for Tracheal Intubation in Critically Ill Children: A Report From National Emergency Airway Registry for Children. Pediatr Crit Care Med, 19(6), 528–537. https://doi.org/10.1097/PCC.0000000000001531
Kojima, Taiki, Ilana Harwayne-Gidansky, Asha N. Shenoi, Erin B. Owen, Natalie Napolitano, Kyle J. Rehder, Michelle A. Adu-Darko, et al. “Cricoid Pressure During Induction for Tracheal Intubation in Critically Ill Children: A Report From National Emergency Airway Registry for Children.Pediatr Crit Care Med 19, no. 6 (June 2018): 528–37. https://doi.org/10.1097/PCC.0000000000001531.
Kojima T, Harwayne-Gidansky I, Shenoi AN, Owen EB, Napolitano N, Rehder KJ, et al. Cricoid Pressure During Induction for Tracheal Intubation in Critically Ill Children: A Report From National Emergency Airway Registry for Children. Pediatr Crit Care Med. 2018 Jun;19(6):528–37.
Kojima, Taiki, et al. “Cricoid Pressure During Induction for Tracheal Intubation in Critically Ill Children: A Report From National Emergency Airway Registry for Children.Pediatr Crit Care Med, vol. 19, no. 6, June 2018, pp. 528–37. Pubmed, doi:10.1097/PCC.0000000000001531.
Kojima T, Harwayne-Gidansky I, Shenoi AN, Owen EB, Napolitano N, Rehder KJ, Adu-Darko MA, Nett ST, Spear D, Meyer K, Giuliano JS, Tarquinio KM, Sanders RC, Lee JH, Simon DW, Vanderford PA, Lee AY, Brown CA, Skippen PW, Breuer RK, Toedt-Pingel I, Parsons SJ, Gradidge EA, Glater LB, Culver K, Nadkarni VM, Nishisaki A, National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). Cricoid Pressure During Induction for Tracheal Intubation in Critically Ill Children: A Report From National Emergency Airway Registry for Children. Pediatr Crit Care Med. 2018 Jun;19(6):528–537.

Published In

Pediatr Crit Care Med

DOI

ISSN

1529-7535

Publication Date

June 2018

Volume

19

Issue

6

Start / End Page

528 / 537

Location

United States

Related Subject Headings

  • United States
  • Singapore
  • Retrospective Studies
  • Registries
  • Quality Improvement
  • Propensity Score
  • Pressure
  • Pediatrics
  • New Zealand
  • Male