Rapid sequence intubation
Abstract
In emergency medicine, there is no procedure that is more important than taking care of the airway. Numerous methods have been proposed in the literature that are used in the case of a compromised airway, and one of them is rapid sequence intubation (RSI). By definition, RSI is the coordinated, sequential process of preparing, sedating, and paralyzing a patient at high risk of aspiration of gastric contents to allow for emergency endotracheal intubation (ETI). Pharmacological sedation and paralysis are induced in rapid succession to provide optimal conditions for laryngoscopy and ETI. RSI is an advanced airway management technique used in critically ill and severely injured patients to protect the airways from regurgitation and aspiration of gastric contents. The application of the RSI technique, consisting of 15 steps, was first described by Stept and Safar in 1970. Today, it represents the gold standard for emergency management of the airway during rapid induction of general anesthesia. More recently, RSI is also applied at the prehospital level as an alternative method for managing the airways of patients with impaired consciousness, in whom it is assumed that they have a full stomach and there is a chance for their survival.
References
2. Stept WJ, Safar P. Rapid induction-intubation for prevention of gastric-content aspiration. Anesth Analg. 1970;49(4):633–6. doi: 10.1213/00000539-197007000-00027
3. Alvarado AC, Panakos P. Endotracheal Tube Intubation Techniques. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560730/
4. Broderick ED, Sauerberg N, Reed JJ. EMS Pros And Cons Of Drug-Assisted Intubation. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518969/
5. Avery P, Morton S, Raitt J, Lossius HM, Lockey D. Rapid sequence induction: where did the consensus go? Scand J Trauma Resusc Emerg Med. 2021;29(1):64. doi: 10.1186/s13049-021-00883-5
6. Woloszczuk-Gebicka B. RSII: rapid-sequence induction of anaesthesia and intubation of the trachea. Disaster Emerg Med J. 2017; 2(1): 33–8. doi: 10.5603/DEMJ.2017.0006
7. Jaber S, Jung B, Corne P, Sebbane M, Muller L, Chanqueset G, et al. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med. 2010;36(2):248-55. doi:10.1007/s00134-009-1717-8
8. Hitna medicinska služba portal (HMS). Procjena rizika za RSI (4). Dostupno na: https://hitnapomoc.net/procjena-rizika-za-rsi/
9. Chaney B, Brady MF. Sellick Maneuver. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558910/.
10. Acquisto NM, Mosier JM, Bittner EA. Society of Critical Care Medicine clinical practice guidelines for rapid sequence intubation in the critically ill adult patient. Crit Care Med. 2023;51(10):1411-30. doi: 10.1097/CCM.0000000000006000.
11. Woodward M, Schleicher S, Podell J, Chang W, Motta M, Pergakis M, et al. 12 Comparison of induction agents for rapid sequence intubation in refractory status epilepticus. Journal of Clinical and Translational Science. 2023;7(s1):3-4. doi:10.1017/cts.2023.113
12. Greenwood J, ed. EMRA PressorDex Critical Care Medications Guide 5th. Emergency Medicine Residents Association, 2024.
13. Driver BE, Trent SA, Prekker ME, Reardon RF, Brown CA 3rd. Sedative Dose for Rapid Sequence Intubation and Postintubation Hypotension: Is There an Association?. Ann Emerg Med. 2023;82(4):417-24. doi:10.1016/j.annemergmed.2023.05.014
14. Ko CL, Celmins L. Pharmacology for rapid sequence intubation (RSI) airway management in trauma patients. J Med Insight. 2024; 2024(299.11). doi:10.24296/jomi/299.11
15. Tessarolo E, Alkhouri H, Lelos N, Sarrami P, McCarthy S. Review article: Effectiveness and risks of cricoid pressure during rapid sequence induction for endotracheal intubation in the emergency department: A systematic review. Emerg Med Australas. 2022;34(4):484-491. doi: 10.1111/1742-6723.13993.
16. Pavlović A, Trpković S, Anđelić S, Marinković O. Kardiopulmonalna reanimacija – nove preporuke 2015 – 2020. NČ urgent medic HALO 194, 2015;21(3): 182-201.
17. Hitna medicinska služba portal (HMS). Skrb nakon intubacije (12). Dostupno na: https://hitnapomoc.net/skrb-nakon-intubacije/)
18. Burgess MR, Crewdson K, Lockey DJ, Perkins ZB. Prehospital emergency anaesthesia: an updated survey of UK practice with emphasis on the role of standardisation and checklists. Emerg Med J. 2018;35(9):532–7. doi:10.1136/emermed-2017-206592
- Autori zadržavaju autorska prava i pružaju časopisu pravo prvog objavljivanja rada i licenciraju ga "Creative Commons Attribution licencom" koja omogućava drugima da dele rad, uz uslov navođenja autorstva i izvornog objavljivanja u ovom časopisu.
- Autori mogu izraditi zasebne, ugovorne aranžmane za neekskluzivnu distribuciju članka objavljenog u časopisu (npr. postavljanje u institucionalni repozitorijum ili objavljivanje u knjizi), uz navođenje da je članak izvorno objavljen u ovom časopisu.
- Autorima je dozvoljeno i podstiču se da postave objavljeni članak onlajn (npr. u institucionalni repozitorijum ili na svoju internet stranicu) pre ili tokom postupka prijave rukopisa, s obzirom da takav postupak može voditi produktivnoj razmeni ideja i ranijoj i većoj citiranosti objavljenog članka (Vidi Efekti otvorenog pristupa).