Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient

Authors

Nicole M. Acquisto, Department of Pharmacy and Emergency Medicine, University of Rochester Medical Center, Rochester, New York, NY.
Jarrod M. Mosier, Department of Emergency Medicine and Medicine, University of Arizona College of Medicine, Tucson, AZ.
Edward A. Bittner, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.
Asad E. Patanwala, Faculty of Medicine and Health, Sydney School of Pharmacy, The University of Sydney, Sydney, Australia.
Karen G. Hirsch, Department of Neurology and Neurological Sciences and Neurosurgery, Stanford University, Stanford, CA.
Pamela Hargwood, Robert Wood Johnson Library of the Health Sciences, Rutgers University, New Brunswick, NJ.
John M. Oropello, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Ryan P. Bodkin, Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, NY.
Christine M. Groth, Department of Pharmacy, University of Rochester Medical Center, Rochester, New York, NY.
Kevin A. Kaucher, Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM.
Angela A. Slampak-Cindric, Department of Pharmacy, Geisinger Medical Center, Danville, PA.
Edward M. Manno, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
Stephen A. Mayer, Departments of Neurology and Neurosurgery Westchester Medical Center, New York Medical College, New York, NY.
Lars-Kristofer N. Peterson, Departments of Critical Care Medicine and Emergency Medicine, Cooper University Health Care, Camden, NJ.
Jeremy Fulmer, Respiratory Care Services, Geisinger Medical Center, Danville, PA.
Christopher Galton, Departments of Anesthesiology and Perioperative Medicine and Emergency Medicine, University of Rochester Medical Center, Rochester, NY.
Thomas P. Bleck, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
Karin Chase, Departments of Surgery and Emergency Medicine, University of Rochester Medical Center, Rochester, NY.
Alan C. Heffner, Departments of Critical Care and Emergency Medicine, Atrium Healthcare System, Charlotte, NC.
Kyle J. Gunnerson, Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI.
Bryan Boling, Department of Anesthesiology, Division or Critical Care Medicine, University of Kentucky, Lexington, KY.
Michael J. Murray, Departments of Anesthesiology and Internal Medicine/Cardiology, University of Arizona College of Medicine, Phoenix, AZ.

Author Type(s)

Faculty

Journal Title

Critical Care Medicine

First Page

1411

Last Page

1430

Document Type

Article

Publication Date

10-1-2023

Department

Neurology

Abstract

RATIONALE: Controversies and practice variations exist related to the pharmacologic and nonpharmacologic management of the airway during rapid sequence intubation (RSI). OBJECTIVES: To develop evidence-based recommendations on pharmacologic and nonpharmacologic topics related to RSI. DESIGN: A guideline panel of 20 Society of Critical Care Medicine members with experience with RSI and emergency airway management met virtually at least monthly from the panel's inception in 2018 through 2020 and face-to-face at the 2020 Critical Care Congress. The guideline panel included pharmacists, physicians, a nurse practitioner, and a respiratory therapist with experience in emergency medicine, critical care medicine, anesthesiology, and prehospital medicine; consultation with a methodologist and librarian was available. A formal conflict of interest policy was followed and enforced throughout the guidelines-development process. METHODS: Panelists created Population, Intervention, Comparison, and Outcome (PICO) questions and voted to select the most clinically relevant questions for inclusion in the guideline. Each question was assigned to a pair of panelists, who refined the PICO wording and reviewed the best available evidence using predetermined search terms. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used throughout and recommendations of "strong" or "conditional" were made for each PICO question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and best practice statements, when the benefits of the intervention outweighed the risks, but direct evidence to support the intervention did not exist. RESULTS: From the original 35 proposed PICO questions, 10 were selected. The RSI guideline panel issued one recommendation (strong, low-quality evidence), seven suggestions (all conditional recommendations with moderate-, low-, or very low-quality evidence), and two best practice statements. The panel made two suggestions for a single PICO question and did not make any suggestions for one PICO question due to lack of evidence. CONCLUSIONS: Using GRADE principles, the interdisciplinary panel found substantial agreement with respect to the evidence supporting recommendations for RSI. The panel also identified literature gaps that might be addressed by future research.

Recommended Citation

Acquisto, N. M., Mosier, J. M., Bittner, E. A., Patanwala, A. E., Hirsch, K. G., Hargwood, P., Oropello, J. M., Bodkin, R. P., Groth, C. M., Kaucher, K. A., Slampak-Cindric, A. A., Manno, E. M., Mayer, S. A., Peterson, L. N., Fulmer, J., Galton, C., Bleck, T. P., Chase, K., Heffner, A. C., Gunnerson, K. J., Boling, B., & Murray, M. J. (2023). Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient. Critical Care Medicine, 51 (10), 1411-1430. https://doi.org/10.1097/CCM.0000000000006000