Cricoid Pressure during Induction for Tracheal Intubation in Critically Ill Children

A Report from National Emergency Airway Registry for Children

for the National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)528-537
Number of pages10
JournalPediatric Critical Care Medicine
Volume19
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Intubation
Critical Illness
Registries
Emergencies
Pressure
Odds Ratio
Masks
Propensity Score
Laryngoscopy
Singapore
Quality Improvement
New Zealand
General Hospitals
Canada
Patient Care
Japan
Cohort Studies
Retrospective Studies
Logistic Models
Regression Analysis

Keywords

  • aspiration
  • cricoid pressure
  • endotracheal intubation
  • laryngoscopy
  • pediatric intensive care unit
  • regurgitation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

for the 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. Pediatric Critical Care Medicine, 19(6), 528-537. https://doi.org/10.1097/PCC.0000000000001531

Cricoid Pressure during Induction for Tracheal Intubation in Critically Ill Children : A Report from National Emergency Airway Registry for Children. / for the National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI).

In: Pediatric Critical Care Medicine, Vol. 19, No. 6, 01.06.2018, p. 528-537.

Research output: Contribution to journalArticle

for the 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', Pediatric Critical Care Medicine, vol. 19, no. 6, pp. 528-537. https://doi.org/10.1097/PCC.0000000000001531
for the 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. Pediatric Critical Care Medicine. 2018 Jun 1;19(6):528-537. https://doi.org/10.1097/PCC.0000000000001531
for the 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. In: Pediatric Critical Care Medicine. 2018 ; Vol. 19, No. 6. pp. 528-537.
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abstract = "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.",
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TY - JOUR

T1 - Cricoid Pressure during Induction for Tracheal Intubation in Critically Ill Children

T2 - A Report from National Emergency Airway Registry for Children

AU - for the National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

AU - Kojima, Taiki

AU - Harwayne-Gidansky, Ilana

AU - Shenoi, Asha N.

AU - Owen, Erin B.

AU - Napolitano, Natalie

AU - Rehder, Kyle J.

AU - Adu-Darko, Michelle A.

AU - Nett, Sholeen T.

AU - Spear, Debbie

AU - Meyer, Keith

AU - Giuliano, John S.

AU - Tarquinio, Keiko M.

AU - Sanders, Ron C.

AU - Lee, Jan Hau

AU - Simon, Dennis W.

AU - Vanderford, Paula

AU - Lee, Anthony Y.

AU - Brown, Calvin A.

AU - Skippen, Peter W.

AU - Breuer, Ryan K.

AU - Toedt-Pingel, Iris

AU - Parsons, Simon J.

AU - Gradidge, Eleanor A.

AU - Glater, Lily B.

AU - Culver, Kathleen

AU - Nadkarni, Vinay M.

AU - Nishisaki, Akira

AU - Li, Simon

AU - Polikoff, Lee A.

AU - Howell, Joy D.

AU - Nuthall, Gabrielle

AU - Bysani, Gokul K.

AU - Graciano, Ana L.

AU - Emeriaud, Guillaume

AU - Saito, Osamu

AU - Orioles, Alberto

AU - Walson, Karen

AU - Jung, Philipp

AU - Al-Subu, Awni M.

AU - Ikeyama, Takanari

AU - Shetty, Rakshay

PY - 2018/6/1

Y1 - 2018/6/1

N2 - 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.

AB - 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.

KW - aspiration

KW - cricoid pressure

KW - endotracheal intubation

KW - laryngoscopy

KW - pediatric intensive care unit

KW - regurgitation

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