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Effect of cricoid force on airway calibre in children: a bronchoscopic assessment

R W M Walker1, R Ravi, K Haylett

  • 1Royal Manchester Children's Hospital, Central Manchester NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK. robert.walker@cmft.nhs.uk

British Journal of Anaesthesia
|November 28, 2009
PubMed

Insights

Cricoid force (CF) can obstruct a child's airway, even at forces below the recommended 30 N. Lower forces are needed for younger children to prevent airway compression.

Area of Science:

  • Anesthesiology
  • Pediatric Airway Management
  • Emergency Medicine

Background:

  • Cricoid force (CF) application during emergency inductions can lead to airway obstruction.
  • Effective airway management in children requires understanding the forces that compromise the subglottic airway.

Purpose of the Study:

  • To investigate the effect of cricoid force (CF) on the subglottic airway caliber in children.
  • To determine the objective force required to cause significant subglottic airway compression in pediatric patients.

Main Methods:

  • Studied 30 pediatric patients (3 months to 15 years) undergoing procedures requiring tracheal intubation.
  • Assessed the impact of CF on subglottic airway dimensions.
  • Objectively measured the force causing ≥50% distortion/compression of the subglottic airway.

Main Results:

  • A linear relationship was observed between patient age/weight and the required CF.
  • The mean force for airway compression was 10.5 N.
  • Compressive forces ranged from 5 N in infants (<1 year) to 15-25 N in teenagers.

Conclusions:

  • Significant subglottic airway compression in children can occur with forces well below the previously recommended 30 N.
  • Age and weight are critical factors influencing the force needed to compress a child's airway.
  • Current recommendations for CF may be excessive and pose a risk of airway compromise in pediatric patients.
Abstract

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