La pression cricoïdienne, mythe ou réalité : une revue de la littérature (podcast)

Since 1961, cricoid pressure also called Sellick's manoeuver, combined with rapid sequence induction, is considered as a main component of the prevention of gastric content inhalation in patient at risk. It has been recommended by national advisory bodies, despite the lack of any randomized trial, supported by individual observation and cadaver studies. Sellick maneuver has been accused of deforming the larynx, of worsening the Cormack and Lehane score and of increasing the difficulty of laryngoscopy. This is due to a lack of knowledge and experience in practicing. The pressure is commonly too high making intubation difficult, but when it is too weak it is ineffective. The pressure is also commonly applied on the thyroid cartilage, causing a distortion of the anatomic structures. Cricoid pressure should be about 10 N in conscious patients, increasing to 30 N after the loss of consciousness. The cricoids pressure technique is still recommended in patients with high risk of regurgitation and inhalation. Learning and training should be promoted on simulators, in combination with monitoring of the value of pressure. This may lead to more homogeneous practices and may clarify the controversy.