Rapid sequence intubation (RSI) in children

INTRODUCTION

Rapid sequence intubation (RSI) describes a sequential process of preparation, sedation, and paralysis to facilitate safe, emergent tracheal intubation. Pharmacologic sedation and paralysis are induced in rapid succession to quickly and effectively perform laryngoscopy and tracheal intubation. At the same time, careful preparation (including preoxygenation) and the use of specific techniques (such as applying cricoid pressure and avoiding positive pressure ventilation) minimize the risks of hypoxia and aspiration.

In the emergency department (ED), RSI is generally the preferred method for emergently intubating patients who have varying levels of consciousness and are presumed to have a full stomach [1,2].

The success of the procedure depends upon the following:

Sedation and paralysis eliminate protective airway reflexes and spontaneous respiration. Therefore, difficulties with intubation and/or ventilation must be anticipated and contingency plans for a failed intubation developed.

The choice of pharmacologic agents for sedation and paralysis is determined based on clinical features that will affect the patient's response to the drug, such as hypotension or preexisting conditions, such as asthma.

                                   

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Literature review current through: Jul 2014. | This topic last updated: Mar 13, 2014.
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