Airway management is often complicated with the occurrence of airway contamination in the form of blood or regurgitated material, especially in cases of out-of-hospital-cardiac arrest (OHCA). A 2011 review of major complications of hospital based airway management in the United Kingdom sited aspiration as the primary cause of death in operating room and intensive care unit tracheal intubations (NAP4 Study 1). The incidence of regurgitation and aspiration that occurs during rescue for OHCA has been quantified between 25-30% in the peer-reviewed literature. (2) Airway contamination has been recognized as a significant cause of failure in first-attempt tracheal intubation in a study of intensive care airway management (6), potentially increasing the occurrence of adverse events during airway management such as severe hypoxemia, hypotension, aspiration and cardiac arrest (7). A recent innovation in airway management includes the proactive use of suction during basic and advanced airway management in the form of the Suction Assisted Laryngoscopy & Airway Decontamination (SALAD Technique) to address the problem of massive airway contamination (5).
The SALAD technique is intended to prevent massive aspiration during emergency airway management through the use of preemptive suctioning of the upper airway prior to basic and advanced life support maneuvers, and to further utilize the rigid suction catheter to assist the insertion of oral airways, SGAs and laryngoscopes with mechanical distraction of the tongue into the floor of the mouth and elevation of its base from the posterior pharyngeal wall.
Utilizing proactive suctioning of the oropharynx and hypopharynx as the initial step in emergency airway management will reduce the potential to force aspiration of airway contaminants during face mask ventilation and ventilation through SGAs. The method by which the rigid suction catheter is utilized to assist the insertion of an OPA, SGA or laryngoscope is in the manner of a laryngoscope blade itself: Compress the tongue into the floor of the mouth, distract the lower mandible inferiorly and lift the base of tongue off the posterior pharyngeal wall. During laryngoscopy, the rigid suction catheter is maintained in the upper esophageal inlet to decontaminate the hypopharynx during visualization of the larynx and tracheal tube delivery.
Continually suctioning the hypopharynx of blood, emesis and secretions during laryngoscopy has been found to reduce the chance of failure to intubate in two peer-reviewed case reports (3, 4).
Peer reviewed literature of the SALAD Technique encompass 6 studies in simulation that demonstrate increased confidence and proficiency among study participants in managing a simulated contaminated airway, and two clinical case reports of successful use in the management of severely contaminated airways.
Abbreviations: SALAD, (Suction Assisted Laryngoscopy and Airway Decontamination)
Recommendation for the use of SALAD in the Prehospital Environment
SALAD can be considered in specific clinical circumstances relating to copious secretions, blood, or emesis, but the operator must be technically proficient in order to not impair the view of the airway with the suction device. Use of the SALAD technique has focused on the management of contaminated airways, however, the proactive use of a rigid suction catheter to create oropharyngeal and hypopharyngeal space during OPA, SGA or laryngoscope insertion suggest that the technique may have wider application in emergency airway management to facilitate basic and advanced airway management.
Specific Equipment to Optimize SALAD Performance
A collection of SALAD Literature & Links
Gary Gulman On How The States Got Their Abbreviations | CONAN on TBS
FAQ
What is the acronym SALAD?
What is the medical technique SALAD?
What is the mnemonic for airway decontamination?
What is the meaning of word salad?
Word salad is the use of words with no apparent meaning attached to them or to their relationship to one another. A nurse is caring for a client with delirium who states, “Look at the spiders on the wall.” The nurse makes which response to the client? a.
What are the ingredients good for making a salad?
A good salad includes vegetables, seeds, some cereal or legumes such as rice, lentils, and chickpeas. It can also include egg and some topping with dressings, honey, and oil, among others.
What is a Cobb salad?
An instant classic, the Cobb is a chopped salad made up of lettuce, hard-boiled eggs, chicken, bacon, avocado, Roquefort cheese (blue cheese is often substituted), tomatoes, and red wine vinaigrette. It is hearty and filling, and a little bit decadent as far as salads go. And yes, it was actually named after a person.
Why is Cobb salad on the Brown Derby menu?
There is some disagreement though over whether Cobb or his head chef, Robert Kreis, made the bold move to officially add the item on the menu in the first place. But all agree that it came to be at the restaurant and was named for Cobb. As soon as the Cobb Salad was put on the Brown Derby restaurant’s menu, it became every foodie nearby’s favorite.