Preview content: Universal Guidelines for Rapid Sequence Intubation

Definition of Rapid sequence intubation:

Rapid sequence intubation (RSI) is an intubation technique performed to reduce the risk and consequences of aspiration during tracheal intubation. The term ‘rapid’ refers to minimising the time interval between the pharmacologically induced loss of normal intrinsic airway protective reflexes and protection of the airway via correct placement of a tracheal tube such that an adequate seal with the tracheal wall is obtained (typically by inflation of the cuff). It does not refer to rushing to reduce the time between the decision to intubate and securing the airway.

RECOMMENDED components of RSI:

These refer to elements on which there is evidence &/or universal consensus on their contribution to the goals of RSI. These represent the defining aspects that must be included in order for an intubation technique to be referred to as RSI. Note that many other elements (e.g. use of ETCO2 monitoring, pulse oximetry, etc.) may be viewed as essential to all safe airway management practice, irrespective of whether or not RSI was being undertaken. While these other elements might become even more important during RSI and would be expected to be used, they are not defining characteristics of RSI. Any intubation technique including all essential elements can be referred to as RSI, independent of any other variations undertaken. The term ‘modified RSI’ should not be used.

SUGGESTED components of rsI:

These refer to elements contributing to the goals of RSI that should typically be adhered to but which clinicians may legitimately decide to omit in a particular context, while still being able to refer to the technique employed as RSI.

Optional components of RSI:

These elements may theoretically contribute to the goals of RSI but their is insufficient evidence to either support or reject their inclusion as elements. They may be incorporated into the practice of RSI at the clinicians discretion. The optional nature of these elements does not imply that they are inconsequential. In a particular context a clinician may consider them important to safe conduct of RSI.