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Canadian Journal of Anesthesia

, Volume 54, Issue 9, pp 748–764 | Cite as

No evidence for decreased incidence of aspiration after rapid sequence induction

  • David T. Neilipovitz
  • Edward T. Crosby
Evidence- Based Clinical Update

Abstract

Purpose

The purpose of this structured, evidence-based, clinical update was to determine if rapid sequence induction is a safe or effective technique to decrease the risk of aspiration or other complications of airway management.

Source

In June 2006 a structured search of medline from 1966 to present using OVID software was undertaken with the assistance of a reference librarian. Medical subject headings and text words describing rapid sequence induction or intubation (RSI), crash induction or intubation, cricoid pressure and emergency airway intubation were employed. OVID’s therapy (sensitivity) algorithm was used to maximize the detection of randomized trials while excluding non-randomized research. The bibliographies of eligible publications were hand-searched to identify trials not identified in the electronic search.

Principal findings

A total of 184 clinical trials were identified of which 163 were randomized controlled trials (RCTs). Of these clinical trials, 126 evaluated different drug regimens with 114 being RCTs. Only 21 clinical trials evaluated non-pharmacologic aspects of the RSI with 18 RCTs identified. A parallel search found 52 trials evaluating cricoid pressure (outside of the context of an RSI technique) with 44 classified as RCTs. Definitive outcomes such as prevention of aspiration and mortality benefit could not be evaluated from the trials. Likewise, the impact on adverse outcomes of the different components of RSI could not be ascertained.

Conclusion

An absence of evidence from RCTs suggests that the decision to use RSI during management can neither be supported nor discouraged on the basis of quality evidence.

Keywords

Tracheal Intubation Succinylcholine Rocuronium Airway Management Etomidate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Aucune donnée probante concernant l’incidence réduite d’inhalation après l’induction en séquence rapide

Résumé

Objectif

Cette mise à jour clinique structurée, basée sur des données probantes, avait pour objectif de déterminer si l’induction en séquence rapide est une technique sécuritaire ou efficace pour réduire le risque d’inhalation ou d’autres complications de prise en charge des voies respiratoires.

Source

Une recherche structurée de MEDLINE, allant de 1966 à nos jours, à l’aide du logiciel OVID, a été entreprise en juin 2006 avec l’assistance d’un bibliothécaire documentaliste. Les titres de sujets et les termes de textes médicaux décrivant l’induction ou l’intubation en séquence rapide (RSI), la «crash induction» ou intubation, la pression cricox00CF:dienne et l’intubation des voies respiratoires en urgence ont été utilisés. L’algorithme de thérapie (sensibilité) d’OVID a servi à maximiser la détection d’études randomisées tout en excluant les recherches non randomisées. Les bibliographies des publications admissibles ont été cherchées manuellement pour identifier les études qui n’avaient pas été relevées par la recherche électronique.

Constatations principales

Au total, 184 études cliniques ont été identifiées, desquelles 163 étaient des études randomisées contrôlées (RCT). De ces études cliniques, 126 ont évalué différents régimes médicamenteux, 114 étant des RCT. Seules 21 études cliniques ont évalué des aspects non pharmacologiques de l’induction en séquence rapide, dont 18 étaient des RCT. Une recherche parallèle a mis en évidence 52 études évaluant la pression cricoÏdienne (hors du contexte d’une technique de RSI), dont 44 étaient classées comme RCT. Des pronostics définitifs, tels que la prévention d’une inhalation et les bienfaits par rapport à la mortalité, n’ont pas pu être évalués à partir des études. De même, l’impact sur les devenirs indésirables des différentes composantes de la RSI n’a pas pu être déterminé.

Conclusion

Un manque de données probantes issues de RCT suggère que la décision d’utiliser la RSI pendant la prise en charge d’un patient ne peut être ni recommandée ni déconseillée sur la base de données probantes de qualité.

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© Canadian Anesthesiologists 2007

Authors and Affiliations

  1. 1.Departments of AnesthesiologyThe Ottawa Hospital and the University of OttawaOttawaCanada
  2. 2.Departments of Critical Care MedicineThe Ottawa Hospital and the University of OttawaOttawaCanada

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