Document Detail

No evidence for decreased incidence of aspiration after rapid sequence induction.
MedLine Citation:
PMID:  17766743     Owner:  NLM     Status:  MEDLINE    
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.
David T Neilipovitz; Edward T Crosby
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  54     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-09-03     Completed Date:  2007-12-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  748-64     Citation Subset:  IM    
Department of Anesthesiology, The Ottawa Hospital and the University of Ottawa, Ontario K1Y 4E9, Canada.
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MeSH Terms
Anesthesia, General / adverse effects*,  methods
Cricoid Cartilage
Drug Administration Schedule
Evidence-Based Medicine
Intubation, Intratracheal / methods*
Oxygen Inhalation Therapy / methods
Respiratory Aspiration / etiology,  prevention & control*
Respiratory Mechanics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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