40 cm H2O PIP in infants and children. An additional benefit of cricoid pressure occurs in paralyzed patients in whom gastric insufflation occurs at lower inflation pressures. Controversy Anterior cricoid pressure was considered the standard of care during Rapid Sequence Intubation for many years. The American Heart Association, until the 2010 science update, advocated the use of cricoid pressure during resuscitation using a BVM, and during emergent oral endotracheal intubation; effective 2010, use of Cricoid Pressure is now discouraged during the routine intubation of cardiac arrest victims. Cricoid pressure may frequently be applied incorrectly. Cricoid pressure may frequently displace the esophagus laterally, instead of compressing it as described by Sellick. Several studies demonstrate some degree of glottic compression reduction in tidal volume and increase in peak pressures. The initial proposal of cricoid pressure as a useful clinical procedure, its subsequent adoption as the lynchpin of patient safety, and its current decline into disfavor represents a classic example of the need for evidence-based medicine, and the evolution of medical practice. Side effects As all techniques, cricoid pressure has indications, contraindications and side effects. It is associated with nausea/vomiting and it may cause esophageal rupture and also may make tracheal intubation and make ventilation difficult or impossible. Cricoid force greater than 40 N can compromise airway patency and make tracheal intubation difficult. Cricoid pressure may displace the esophagus, make ventilation with a facemask or with a laryngeal mask airway (LMA) more difficult, interfere with LMA placement and advancement of a tracheal tube and alter laryngeal visualization by a flexible bronchoscope. However, other investigators have found that cricoid pressure does not increase the rate of failed intubation. See also Rapid sequence induction Intubation Mechanical ventilation References Airway management Emergency medical procedures