Cricoid Pressure During Intubation and Airway Management

Cricoid pressure is an airway maneuver used during endotracheal intubation, especially when a patient is at risk for aspiration. Also called the Sellick maneuver, it involves applying pressure over the cricoid cartilage during laryngoscopy. The goal is to reduce the chance of gastric contents entering the airway while also potentially improving visualization of the glottis.

Although the concept is simple, the maneuver requires proper technique and careful judgment. For respiratory therapists, understanding cricoid pressure is important because it may be requested during intubation, rapid sequence intubation, and emergency airway management.

What is Cricoid Pressure?

Cricoid pressure is the application of external pressure over the cricoid cartilage during intubation. The cricoid cartilage is a ring-shaped structure located just below the thyroid cartilage and above the trachea. Because it forms a complete ring around the airway, it has traditionally been viewed as a useful site for applying pressure during airway procedures.

The maneuver is commonly known as the Sellick maneuver. It was designed to help reduce the risk of aspiration during induction of anesthesia or emergency airway management. The idea is that pressure applied to the cricoid cartilage can compress the esophagus against the cervical vertebral bodies behind it. This may help limit passive regurgitation of stomach contents into the pharynx during intubation.

In respiratory care, cricoid pressure is most often discussed in relation to endotracheal intubation and rapid sequence intubation. The respiratory therapist may be asked to assist the physician or advanced airway provider by applying pressure over the cricoid cartilage while the airway is being visualized and the endotracheal tube is being inserted.

Anatomy of the Cricoid Cartilage

The cricoid cartilage is part of the laryngeal framework. It forms the lower border of the larynx and sits directly below the thyroid cartilage, which forms the Adam’s apple. Below the cricoid cartilage is the trachea, which extends downward into the thorax before dividing into the right and left mainstem bronchi.

A key feature of the cricoid cartilage is that it forms a complete ring. This makes it different from the tracheal cartilages below it, which are C-shaped and open posteriorly. Because the cricoid fully encircles the airway, it provides structural support at the lower part of the larynx.

This location makes the cricoid cartilage an important airway landmark. It helps mark the transition from the larynx to the trachea, and it lies near the cricothyroid membrane, which is located between the thyroid cartilage above and the cricoid cartilage below. The cricothyroid membrane is the access site for emergency cricothyrotomy, which is different from cricoid pressure but closely related anatomically.

Why Cricoid Pressure is Used

The main purpose of cricoid pressure is to reduce the risk of aspiration during intubation. Aspiration occurs when gastric contents enter the airway and lungs. This can lead to serious complications, including airway obstruction, chemical pneumonitis, pneumonia, hypoxemia, and respiratory failure.

Aspiration risk is especially concerning when a patient has a full stomach, impaired consciousness, trauma, pregnancy, bowel obstruction, delayed gastric emptying, or an emergency condition that prevents proper fasting before intubation. During intubation, sedatives and paralytic medications may reduce or eliminate protective airway reflexes. If the patient regurgitates during this period, they may be unable to cough or protect the airway.

Cricoid pressure is intended to reduce this risk by compressing the esophagus. The maneuver is often associated with rapid sequence intubation because RSI is used when a patient needs urgent airway control and is considered at increased risk for aspiration.

A secondary purpose of cricoid pressure is that it may improve visualization of the glottis during laryngoscopy. In some cases, external pressure over the laryngeal structures can improve alignment and make the vocal cords easier to see. However, cricoid pressure must be applied carefully because incorrect or excessive pressure can worsen the view or obstruct the airway.

Cricoid Pressure and the Sellick Maneuver

The Sellick maneuver refers specifically to applying pressure over the cricoid cartilage during intubation. In practice, the terms “cricoid pressure” and “Sellick maneuver” are often used interchangeably.

The classic technique involves identifying the cricoid cartilage and applying firm backward pressure. The pressure is directed posteriorly, toward the cervical spine. The goal is to compress the esophagus between the cricoid cartilage and the vertebral column.

In an intubation setting, this maneuver requires coordination. One clinician performs laryngoscopy and inserts the endotracheal tube, while another clinician applies cricoid pressure. The person applying pressure must maintain steady technique and be ready to adjust or release pressure if the airway provider reports difficulty with ventilation, visualization, or tube passage.

Note: For respiratory therapists, this means the maneuver is not just a memorized definition. It is a hands-on airway support skill that must be performed correctly and modified when needed.

Role During Rapid Sequence Intubation

Rapid sequence intubation is a controlled approach to emergency airway management that uses sedative and paralytic medications to facilitate endotracheal intubation. It is commonly used when the patient needs urgent airway control and is at risk for aspiration.

Cricoid pressure has historically been included as part of the RSI sequence. The typical process includes preparing equipment, preoxygenating the patient, administering medications, applying cricoid pressure, performing laryngoscopy, inserting the endotracheal tube, confirming placement, and stabilizing the patient on appropriate ventilatory support.

In this setting, cricoid pressure is meant to protect the airway during the period when the patient is sedated and paralyzed but not yet intubated. This is a vulnerable time because the patient may not be able to maintain airway reflexes, cough effectively, or protect against regurgitation.

The respiratory therapist may assist by preparing the bag-valve-mask, suction, oxygen source, endotracheal tubes, stylet, capnography device, and ventilator. The RT may also help with preoxygenation, manual ventilation when indicated, monitoring oxygen saturation, applying cricoid pressure if requested, and confirming tube placement after intubation.

How Cricoid Pressure is Applied

Proper technique begins with identifying the cricoid cartilage. The thyroid cartilage is located higher in the neck and is usually more prominent, especially in adult males. The cricoid cartilage is located just below it. It can often be felt as a firm ring-like structure above the trachea.

During the maneuver, pressure is applied directly over the cricoid cartilage. The pressure should be directed backward toward the spine. It should not be applied over the thyroid cartilage, soft tissues of the neck, or the trachea below the cricoid.

The amount of pressure must be controlled. Too little pressure may not be effective. Too much pressure can distort the airway, worsen laryngoscopic view, obstruct ventilation, or make tube passage more difficult. This is why the person performing the maneuver must be attentive to feedback from the airway provider.

Note: If the physician or intubating clinician says that the view is poor, ventilation is difficult, or the endotracheal tube will not pass, cricoid pressure may need to be adjusted or released. The priority is always successful oxygenation, ventilation, and airway control.

Potential Benefits of Cricoid Pressure

The main potential benefit of cricoid pressure is reducing the risk of aspiration during intubation. By compressing the esophagus, the maneuver is intended to reduce the upward movement of gastric contents into the pharynx.

Another possible benefit is improved visualization of the glottis. In some patients, external pressure over the cricoid region can help align upper airway structures. This may allow the airway provider to see the vocal cords more clearly during laryngoscopy.

Cricoid pressure may also provide a structured role for the respiratory therapist during intubation. When performed correctly, it can support the airway provider and contribute to a safer procedure, especially in high-risk patients.

Note: These benefits are not guaranteed. The maneuver must be performed properly, and it must not interfere with more important goals such as oxygenation, ventilation, and successful tube placement.

Risks and Limitations

Cricoid pressure has important limitations. One of the main concerns is that excessive pressure can obstruct the airway. Instead of compressing only the esophagus, the maneuver may narrow the airway or distort the laryngeal anatomy. This can make bag-mask ventilation more difficult or worsen the laryngoscopic view.

Another concern is that cricoid pressure may make intubation harder. If the pressure shifts the larynx out of alignment or compresses airway structures, the endotracheal tube may be more difficult to pass through the vocal cords. In an emergency, this can delay intubation and increase the risk of hypoxemia.

Cricoid pressure may also be applied incorrectly. If pressure is placed over the wrong structure, such as the thyroid cartilage, it may not compress the esophagus as intended. It may also increase discomfort, distort the airway, or fail to provide any protective benefit.

There is also ongoing debate in clinical practice about how effective cricoid pressure is at preventing aspiration. While it remains an important board-relevant concept, clinicians should understand that it is not a substitute for suction, proper positioning, rapid airway control, cuff inflation, and tube placement confirmation.

Cricoid Pressure vs. BURP Maneuver

Cricoid pressure should not be confused with the BURP maneuver. BURP stands for backward, upward, and rightward pressure. It is a laryngeal manipulation technique used to improve visualization of the glottis during laryngoscopy.

Cricoid pressure is primarily intended to reduce aspiration risk by compressing the esophagus. BURP is primarily intended to improve the view of the vocal cords. Both involve external pressure on the neck, but they are not the same maneuver.

Another related concept is external laryngeal manipulation. In this technique, the airway provider may guide another clinician’s hand to adjust the larynx into a better position for visualization. This differs from standard cricoid pressure because the goal is directly focused on improving the laryngoscopic view rather than esophageal compression.

Note: For students, the key distinction is simple: Sellick maneuver means cricoid pressure for aspiration risk reduction. BURP means external laryngeal pressure to improve glottic visualization.

Cricoid Pressure vs. Cricothyrotomy

Cricoid pressure should also not be confused with cricothyrotomy. Although the terms sound similar and involve nearby anatomy, they refer to very different procedures.

Cricoid pressure is a noninvasive external maneuver used during intubation. It involves pressing on the cricoid cartilage from the outside of the neck.

Cricothyrotomy is an invasive emergency airway procedure. It involves creating an opening through the cricothyroid membrane, which lies between the thyroid cartilage and cricoid cartilage. This procedure may be needed when a patient cannot be intubated and cannot be ventilated by other means.

Note: The cricoid cartilage helps identify the cricothyroid membrane, but applying cricoid pressure is not the same as performing a cricothyrotomy. This distinction is important for respiratory therapy students because both topics may appear in airway management questions.

Cricoid Pressure and Pediatric Airways

The cricoid region is especially important in pediatric airway management. In adults, the narrowest part of the upper airway is generally the glottic opening. In infants and young children, the narrowest portion is often described as the cricoid cartilage region.

This matters because children have smaller airways, and small changes in diameter can greatly increase resistance to airflow. Mild swelling, secretions, poor positioning, or an incorrectly sized endotracheal tube can significantly affect ventilation.

The pediatric airway is also anatomically different from the adult airway. Infants have larger heads relative to body size, smaller nasal passages, larger tongues relative to the oral cavity, and a higher laryngeal position. Neck flexion can obstruct the airway, especially if muscle tone is poor. Proper positioning is essential, often with the head and neck placed in a neutral or slightly extended sniffing position.

Because the cricoid region may be the narrowest pediatric airway point, clinicians must be cautious when selecting and placing endotracheal tubes. An oversized tube may cause trauma or swelling. An undersized tube may increase airway resistance, cause excessive leak, or interfere with ventilation.

Relationship to Endotracheal Tube Placement

Cricoid pressure is closely tied to endotracheal intubation because it is applied during the process of placing an endotracheal tube into the trachea. The purpose of intubation is to establish and maintain a secure airway, support ventilation, protect against aspiration, allow suctioning, and provide a connection to mechanical ventilation.

During intubation, the endotracheal tube must pass through the mouth or nose, through the pharynx, past the vocal cords, and into the trachea. The airway provider must visualize the glottis and guide the tube into the correct position. If the tube enters the esophagus instead of the trachea, ventilation will not reach the lungs and the patient can deteriorate quickly.

The respiratory therapist assists by monitoring the patient, preparing equipment, suctioning as needed, supporting ventilation, and helping confirm placement. Cricoid pressure may be one part of this process, but it does not replace the need for careful tube verification.

Confirming Tube Placement After Intubation

After the endotracheal tube is inserted, confirmation is essential. Breath sounds should be assessed bilaterally, chest rise should be observed, and end-tidal carbon dioxide detection should be used when available. The tube should be secured, and a chest x-ray may be obtained to confirm depth and position.

The respiratory therapist may inflate the cuff, manually ventilate the patient with a bag-valve-mask, connect the patient to the ventilator, monitor oxygen saturation, and assess the patient’s response. If breath sounds are absent on one side, the tube may be too deep, often in the right mainstem bronchus. If there is no carbon dioxide detection and no chest rise, esophageal intubation must be suspected.

Cricoid pressure is normally released after the airway is secured and tube placement is confirmed, depending on the provider’s direction. Once the cuff is inflated and the tube is confirmed in the trachea, the risk of aspiration is reduced compared with the unsecured airway period.

Respiratory Therapist’s Role

The respiratory therapist plays an important support role during intubation. The RT may not be the person inserting the endotracheal tube in many settings, but their responsibilities are still essential.

Before intubation, the RT helps prepare equipment. This may include selecting appropriate endotracheal tube sizes, checking cuff integrity, preparing suction, setting up oxygen delivery, ensuring the bag-valve-mask works properly, preparing capnography, and having backup airway devices available.

During intubation, the RT monitors the patient’s oxygen saturation, heart rate, respiratory status, and overall tolerance of the procedure. The RT may assist with preoxygenation, suctioning, manual ventilation, and cricoid pressure if requested.

After intubation, the RT helps confirm tube placement, secure the airway, initiate mechanical ventilation, adjust ventilator settings, monitor the patient’s response, and communicate changes to the physician or care team.

Note: Cricoid pressure is only one possible task, but it must be understood within the larger airway management process.

When Cricoid Pressure May Need to Be Released

Cricoid pressure should not be continued blindly if it is causing problems. If the airway provider reports difficulty visualizing the glottis, difficulty passing the tube, or inability to ventilate, pressure may need to be reduced, repositioned, or released.

The same applies if the patient’s oxygen saturation is falling and bag-mask ventilation becomes difficult. Maintaining oxygenation is more important than continuing a maneuver that may be obstructing the airway.

Communication is critical. The person applying cricoid pressure should listen carefully to the airway provider and respond immediately to instructions. The maneuver should be steady, controlled, and adjustable.

Note: This is especially important during difficult airway situations, trauma, and RSI, where time is limited and the patient may deteriorate quickly.

Difficult Airway Considerations

Cricoid pressure may be discussed in the same general context as difficult airway management. If a difficult airway is predicted, the team should prepare backup equipment and alternative plans before intubation begins.

A difficult airway may be suspected based on limited mouth opening, facial trauma, obesity, airway obstruction, poor neck mobility, abnormal anatomy, or a high Mallampati score. The L-E-M-O-N mnemonic is often used to help predict difficulty: Look externally, Evaluate anatomy, Mallampati classification, Obesity or obstruction, and Neck mobility.

If intubation is expected to be difficult, the team may prepare devices such as a videolaryngoscope, fiberoptic bronchoscope, supraglottic airway, bougie, lightwand, or cricothyrotomy kit. Cricoid pressure may still be used, but it must not interfere with intubation or ventilation.

In patients with possible cervical spine injury, manual inline stabilization may be needed. This can limit head and neck positioning, making direct laryngoscopy more challenging. In these cases, cricoid pressure must be coordinated carefully with spinal precautions and airway visualization.

Cricoid Pressure and Aspiration Risk

Aspiration prevention is one of the main reasons cricoid pressure is taught. However, aspiration prevention during intubation requires more than one maneuver.

The airway team should suction the mouth and pharynx as needed, preoxygenate the patient, minimize unnecessary bag-mask ventilation in high-risk patients when appropriate, use proper positioning, intubate efficiently, inflate the cuff, and confirm tube placement. If vomiting or regurgitation occurs, suctioning and rapid airway control become priorities.

Cricoid pressure may help reduce aspiration risk, but it does not eliminate it. A patient can still aspirate despite the maneuver, especially if regurgitation is forceful, technique is poor, or airway control is delayed.

Note: For this reason, respiratory therapists should view cricoid pressure as one tool in a larger airway safety strategy.

Common Mistakes

One common mistake is applying pressure to the wrong structure. The cricoid cartilage lies below the thyroid cartilage, and the provider must identify it correctly before applying pressure.

Another mistake is using too much pressure. Excessive pressure can obstruct the airway, worsen glottic visualization, or make intubation more difficult. The pressure should be firm but controlled.

A third mistake is failing to communicate. The person applying cricoid pressure must respond to the airway provider’s instructions. If the provider asks for pressure to be adjusted or released, this should be done promptly.

Another common misunderstanding is thinking cricoid pressure guarantees aspiration prevention. It does not. It may reduce risk in some situations, but safe airway management still depends on preparation, suctioning, oxygenation, skilled intubation, tube confirmation, and post-intubation care.

Key Takeaways

For respiratory therapy students, cricoid pressure is most likely to appear in questions about intubation, rapid sequence intubation, aspiration prevention, and the respiratory therapist’s role during airway management.

If a question mentions the Sellick maneuver, the answer usually involves applying pressure over the cricoid cartilage. If a question asks why it is used, the best answer is to reduce aspiration risk by compressing the esophagus. A secondary answer may involve improving glottic visualization, depending on the wording of the question.

If a question describes emergency invasive access through the cricothyroid membrane, that is cricothyrotomy, not cricoid pressure. If a question describes external laryngeal manipulation to improve visualization, that may refer to the BURP maneuver or external laryngeal manipulation rather than Sellick’s maneuver.

A strong exam summary is this: cricoid pressure, or the Sellick maneuver, is an external maneuver used during intubation in which moderate pressure is applied over the cricoid cartilage to reduce aspiration risk and sometimes improve visualization. It must be applied correctly because excessive or misplaced pressure can obstruct the airway or interfere with intubation.

Clinical Importance

Cricoid pressure is clinically important because it connects airway anatomy with airway protection. The cricoid cartilage is not simply a structure to memorize. It is a landmark used during intubation, RSI, emergency airway planning, and airway assessment.

For respiratory therapists, understanding this maneuver helps improve teamwork during intubation. The RT must know where the cricoid cartilage is located, why pressure may be applied, how the maneuver supports airway protection, and when it may need to be adjusted or released.

The maneuver also highlights a broader principle in airway management: no single step guarantees safety. Intubation requires preparation, positioning, monitoring, oxygenation, suctioning, medication awareness, tube placement verification, and readiness for backup airway strategies.

Cricoid Pressure Practice Questions

1. What is cricoid pressure?
Cricoid pressure is an external airway maneuver in which pressure is applied over the cricoid cartilage during intubation to help reduce aspiration risk and, in some cases, improve visualization of the glottis.

2. What is another name for cricoid pressure?
Cricoid pressure is also called the Sellick maneuver.

3. Where is the cricoid cartilage located?
The cricoid cartilage is located below the thyroid cartilage and above the trachea, forming the lower border of the larynx.

4. What is the main purpose of applying cricoid pressure during intubation?
The main purpose is to reduce the risk of aspiration by compressing the esophagus during airway management.

5. How does cricoid pressure help reduce aspiration risk?
Cricoid pressure is intended to compress the esophagus against the cervical vertebrae, limiting the upward movement of gastric contents into the pharynx.

6. During what airway procedure is cricoid pressure commonly used?
Cricoid pressure is commonly used during endotracheal intubation, especially during rapid sequence intubation.

7. What does the Sellick maneuver involve?
The Sellick maneuver involves applying moderate pressure over the cricoid cartilage during intubation.

8. Why is the cricoid cartilage an important landmark for this maneuver?
The cricoid cartilage forms a complete ring around the airway, making it a firm anatomical landmark for applying external pressure.

9. What type of pressure should be applied during cricoid pressure?
Moderate downward or posterior pressure should be applied over the cricoid cartilage.

10. Who may be asked to apply cricoid pressure during intubation?
The respiratory therapist may be asked to apply cricoid pressure while assisting the physician or airway provider during intubation.

11. What is one possible secondary benefit of cricoid pressure?
Cricoid pressure may help improve visualization of the glottis during laryngoscopy in some patients.

12. Why must cricoid pressure be applied carefully?
It must be applied carefully because excessive or misplaced pressure can obstruct the airway, worsen visualization, or interfere with endotracheal tube placement.

13. What can happen if too much cricoid pressure is applied?
Too much pressure can distort airway anatomy, close off the airway, make ventilation difficult, or prevent successful intubation.

14. When should cricoid pressure be adjusted or released?
It should be adjusted or released if the airway provider reports difficulty visualizing the vocal cords, ventilating the patient, or passing the endotracheal tube.

15. What is rapid sequence intubation?
Rapid sequence intubation is a controlled emergency airway procedure that uses sedative and paralytic medications to facilitate endotracheal intubation.

16. Why is cricoid pressure associated with rapid sequence intubation?
It is associated with rapid sequence intubation because RSI is often performed in patients at increased risk for aspiration.

17. What happens to protective airway reflexes during RSI?
Protective airway reflexes are reduced or absent after sedative and paralytic medications are given, increasing the risk of aspiration if regurgitation occurs.

18. What is the respiratory therapist’s role during intubation?
The respiratory therapist may prepare equipment, support oxygenation and ventilation, monitor the patient, assist with suctioning, apply cricoid pressure if requested, and help confirm tube placement.

19. What equipment should be prepared before intubation?
Equipment may include oxygen, a bag-valve-mask, suction, endotracheal tubes, a stylet, capnography, laryngoscope equipment, backup airway devices, and a ventilator.

20. What is the difference between cricoid pressure and cricothyrotomy?
Cricoid pressure is a noninvasive external maneuver used during intubation, while cricothyrotomy is an invasive emergency airway procedure through the cricothyroid membrane.

21. What is the cricothyroid membrane?
The cricothyroid membrane is the membrane located between the thyroid cartilage and the cricoid cartilage.

22. Why should cricoid pressure not be confused with cricothyrotomy?
They involve nearby anatomy but are different procedures: cricoid pressure is external pressure, while cricothyrotomy creates an emergency airway opening.

23. What is the BURP maneuver?
The BURP maneuver is backward, upward, and rightward pressure applied to improve visualization of the glottis during laryngoscopy.

24. How is cricoid pressure different from the BURP maneuver?
Cricoid pressure is mainly intended to reduce aspiration risk, while the BURP maneuver is mainly used to improve the view of the vocal cords.

25. What is the narrowest portion of the upper airway in infants and children?
In infants and children, the narrowest portion of the upper airway is commonly described as the cricoid cartilage region.

26. Why is the pediatric cricoid region clinically important?
The pediatric cricoid region is clinically important because it is a narrow airway point where swelling, poor positioning, or an oversized tube can significantly affect ventilation.

27. What is the relationship between the cricoid cartilage and the trachea?
The cricoid cartilage marks the lower border of the larynx and connects with the upper portion of the trachea.

28. How is the cricoid cartilage different from the tracheal cartilage rings?
The cricoid cartilage forms a complete ring, while the tracheal cartilage rings are C-shaped and open posteriorly.

29. Why is the cricoid cartilage useful as an airway landmark?
It is useful because it helps identify the lower larynx, the beginning of the trachea, and nearby structures used in airway procedures.

30. What structure lies between the thyroid cartilage and cricoid cartilage?
The cricothyroid membrane lies between the thyroid cartilage and the cricoid cartilage.

31. What is the main concern if cricoid pressure is applied over the wrong location?
If pressure is applied over the wrong location, it may fail to compress the esophagus and may distort the airway or interfere with intubation.

32. Why is communication important during cricoid pressure?
Communication is important because the person applying pressure must adjust or release it if the airway provider reports difficulty with visualization, ventilation, or tube passage.

33. What should the RT monitor during intubation?
The RT should monitor oxygen saturation, heart rate, respiratory status, vital signs, ECG rhythm when available, and the patient’s overall response.

34. Why is suction important during intubation?
Suction is important because secretions, blood, vomitus, or gastric contents can obstruct visualization and increase the risk of aspiration.

35. What should be done if the patient vomits during intubation?
The airway should be suctioned immediately, oxygenation should be supported, and the team should work quickly to secure and confirm the airway.

36. What does cricoid pressure attempt to compress?
Cricoid pressure attempts to compress the esophagus against the cervical vertebral bodies.

37. What is the glottis?
The glottis is the opening between the vocal cords.

38. How can cricoid pressure affect the glottic view?
Cricoid pressure may improve the glottic view in some cases, but excessive or incorrect pressure can worsen visualization.

39. Why is cricoid pressure not a guarantee against aspiration?
Cricoid pressure is not a guarantee because regurgitation can still occur, technique may be ineffective, or airway control may be delayed.

40. When is aspiration risk increased during intubation?
Aspiration risk is increased when the patient has a full stomach, impaired consciousness, trauma, pregnancy, bowel obstruction, delayed gastric emptying, or loss of protective airway reflexes.

41. What is the purpose of preoxygenation before intubation?
Preoxygenation increases oxygen reserves and helps delay oxygen desaturation during the intubation attempt.

42. How does paralysis during RSI affect airway safety?
Paralysis improves intubating conditions but removes the patient’s ability to protect the airway, breathe spontaneously, or cough effectively.

43. What is one reason cricoid pressure may make ventilation harder?
It may distort or narrow the airway, making bag-mask ventilation more difficult.

44. What is one reason cricoid pressure may make intubation harder?
It may shift or distort laryngeal structures, making it harder to visualize the vocal cords or pass the endotracheal tube.

45. What should the clinician do if cricoid pressure interferes with intubation?
The pressure should be adjusted, reduced, or released based on the airway provider’s instructions.

46. What is the relationship between cricoid pressure and airway protection?
Cricoid pressure is used as an airway protection maneuver because it is intended to reduce passive regurgitation and aspiration during intubation.

47. What is the relationship between cricoid pressure and the endotracheal tube cuff?
Cricoid pressure may be used before the airway is secured, while cuff inflation helps protect the airway after the endotracheal tube is placed in the trachea.

48. When is cricoid pressure usually released?
Cricoid pressure is usually released after the endotracheal tube is placed, the cuff is inflated, and tube placement is confirmed, depending on provider direction.

49. How is tube placement commonly confirmed after intubation?
Tube placement is commonly confirmed using bilateral breath sounds, chest rise, end-tidal carbon dioxide detection, and chest x-ray when indicated.

50. What finding may indicate right mainstem intubation?
Absent or diminished breath sounds on the left side may indicate that the endotracheal tube has been advanced too far into the right mainstem bronchus.

51. What should be suspected if there is no chest rise after intubation?
Esophageal intubation should be suspected if there is no chest rise, no breath sounds, and no carbon dioxide detection after tube placement.

52. Why is end-tidal carbon dioxide detection important after intubation?
End-tidal carbon dioxide detection helps confirm that the endotracheal tube is in the trachea and that gas exchange is occurring.

53. What is the respiratory therapist’s role after the tube is placed?
The respiratory therapist may help inflate the cuff, ventilate the patient, confirm tube placement, secure the tube, connect the ventilator, and monitor the patient’s response.

54. Why should the cuff be inflated after endotracheal tube placement?
The cuff should be inflated to create a seal in the trachea, support effective ventilation, and help reduce the risk of aspiration around the tube.

55. What is one reason a chest x-ray may be ordered after intubation?
A chest x-ray may be ordered to confirm the depth and position of the endotracheal tube.

56. What is the relationship between cricoid pressure and laryngoscopy?
Cricoid pressure may be applied during laryngoscopy to help reduce aspiration risk while the airway provider visualizes the glottis and places the tube.

57. What is the thyroid cartilage commonly known as?
The thyroid cartilage is commonly known as the Adam’s apple.

58. Where is the cricoid cartilage in relation to the thyroid cartilage?
The cricoid cartilage is located below the thyroid cartilage.

59. Where is the trachea in relation to the cricoid cartilage?
The trachea begins below the cricoid cartilage.

60. Why is the cricoid cartilage considered a complete ring?
It is considered a complete ring because it fully encircles the airway, unlike the C-shaped tracheal cartilages.

61. What is the larynx?
The larynx is the voice box that connects the pharynx to the trachea, helps protect the lower airway, and contributes to speech.

62. How is the cricoid cartilage related to the larynx?
The cricoid cartilage forms the lower border of the larynx and helps support the lower laryngeal airway.

63. What is the relationship between the cricoid cartilage and the cricothyroid ligament?
The cricothyroid ligament spans the space between the thyroid cartilage and the cricoid cartilage.

64. What emergency airway procedure uses the cricothyroid membrane?
Cricothyrotomy uses the cricothyroid membrane to establish an emergency airway.

65. What is retrograde intubation?
Retrograde intubation is a difficult-airway technique in which a guidewire is passed through the cricothyroid membrane and used to guide an endotracheal tube into the trachea.

66. How is retrograde intubation different from cricoid pressure?
Retrograde intubation is an invasive guidewire-assisted technique, while cricoid pressure is a noninvasive external maneuver during intubation.

67. What is a laryngeal mask airway?
A laryngeal mask airway is a supraglottic airway device that sits above the laryngeal opening and allows ventilation without entering the trachea.

68. Does a laryngeal mask airway protect against aspiration like an endotracheal tube?
No. A laryngeal mask airway can help ventilate the patient, but it does not protect the airway from aspiration as effectively as a properly placed cuffed endotracheal tube.

69. Why might an LMA be used during a failed intubation attempt?
An LMA may be used as a rescue airway to provide ventilation when endotracheal intubation is difficult or unsuccessful.

70. Why is cricoid pressure relevant when discussing aspiration risk with an LMA?
Cricoid pressure is relevant because it is intended to reduce aspiration risk during intubation, while an LMA does not fully isolate the airway from regurgitated gastric contents.

71. What patient condition may require manual inline stabilization during intubation?
Suspected cervical spine injury may require manual inline stabilization during intubation.

72. Why can cervical spine injury complicate intubation?
Cervical spine injury can limit head and neck positioning, making direct laryngoscopy and airway alignment more difficult.

73. What is the goal of manual inline stabilization?
The goal of manual inline stabilization is to minimize cervical spine movement during airway management.

74. What difficult-airway tools may be prepared if standard laryngoscopy is expected to be challenging?
Possible tools include a videolaryngoscope, fiberoptic bronchoscope, fiberoptic stylet, bougie, lightwand, supraglottic airway, or cricothyrotomy kit.

75. What does the L-E-M-O-N mnemonic help assess?
The L-E-M-O-N mnemonic helps assess the likelihood of a difficult intubation.

76. What does the “Look externally” part of L-E-M-O-N assess?
It assesses visible features that may predict a difficult airway, such as facial trauma, abnormal anatomy, obesity, or limited mouth opening.

77. What does the “Evaluate” part of L-E-M-O-N refer to?
It refers to evaluating external airway anatomy, including mouth opening, jaw size, and other physical features that may affect intubation.

78. What does the “Mallampati” part of L-E-M-O-N help predict?
The Mallampati classification helps predict how difficult it may be to visualize the airway during intubation.

79. What does the “Obesity or obstruction” part of L-E-M-O-N assess?
It assesses whether obesity, airway swelling, foreign body obstruction, trauma, or other blockage may make intubation difficult.

80. What does the “Neck mobility” part of L-E-M-O-N assess?
It assesses whether limited neck movement may interfere with proper airway positioning and laryngoscopy.

81. Why is patient positioning important before intubation?
Proper positioning helps align airway structures, improve glottic visualization, support ventilation, and improve the chance of successful tube placement.

82. What is the sniffing position?
The sniffing position involves slight neck flexion with extension of the head to help align the oral, pharyngeal, and laryngeal axes during intubation.

83. How may cricoid pressure be related to the sniffing position?
Cricoid pressure may be used along with proper positioning to assist airway alignment and reduce aspiration risk during intubation.

84. Why should cricoid pressure be coordinated with the airway provider?
It should be coordinated because the airway provider must be able to see the glottis, pass the tube, and maintain oxygenation without interference from the maneuver.

85. What should the RT do if oxygen saturation begins to fall during intubation?
The RT should alert the airway provider, support oxygenation and ventilation as directed, and be ready to assist with suctioning or backup airway measures.

86. What is the priority if cricoid pressure interferes with ventilation?
The priority is to restore effective oxygenation and ventilation, which may require reducing or releasing cricoid pressure.

87. Why is cricoid pressure considered a supportive maneuver?
It is considered supportive because it assists the intubation process but does not replace proper airway assessment, skilled tube placement, or confirmation of tube position.

88. What is one reason cricoid pressure remains important for board exams?
It remains important because it is strongly associated with the Sellick maneuver, rapid sequence intubation, aspiration prevention, and the RT’s assisting role during intubation.

89. What should students associate with the phrase “pressure over the cricoid cartilage”?
Students should associate this phrase with the Sellick maneuver and airway assistance during intubation.

90. What should students associate with “moderate downward pressure during laryngoscopy”?
They should associate it with cricoid pressure used during intubation to help reduce aspiration risk.

91. Why is cricoid pressure not the same as general neck pressure?
Cricoid pressure must be applied specifically over the cricoid cartilage; general neck pressure may be ineffective or harmful.

92. How can misplaced cricoid pressure affect intubation?
Misplaced pressure can distort airway anatomy, worsen visualization, interfere with tube passage, or fail to reduce aspiration risk.

93. What is the relationship between cricoid pressure and gastric insufflation?
Cricoid pressure is intended to reduce regurgitation risk, but improper airway management or ventilation can still contribute to gastric insufflation and aspiration risk.

94. Why is bag-mask ventilation used carefully in patients at high aspiration risk?
Excessive bag-mask ventilation can insufflate the stomach, increase regurgitation risk, and make aspiration more likely.

95. Why is airway suctioning important before and during intubation?
Airway suctioning clears secretions, vomitus, blood, or other material that may block the view of the vocal cords or enter the lower airway.

96. What should be done if cricoid pressure worsens the laryngoscopic view?
The pressure should be adjusted or released as directed by the airway provider.

97. What is the main difference between aspiration prevention before and after tube placement?
Before tube placement, aspiration prevention depends on positioning, suctioning, airway technique, and maneuvers such as cricoid pressure; after placement, the inflated cuff helps reduce aspiration around the tube.

98. Why is cricoid pressure only one part of safe airway management?
It does not guarantee aspiration prevention or successful intubation, so clinicians must also focus on preparation, monitoring, oxygenation, suctioning, tube confirmation, and backup plans.

99. What is the best board-style summary of cricoid pressure?
Cricoid pressure, or the Sellick maneuver, is moderate pressure applied over the cricoid cartilage during intubation to help reduce aspiration risk.

100. What is the most important clinical caution about cricoid pressure?
The most important caution is that excessive or improperly placed pressure can obstruct the airway, worsen visualization, or interfere with successful intubation.

Final Thoughts

Cricoid pressure during intubation is a supportive airway maneuver that may help reduce aspiration risk by applying pressure over the cricoid cartilage. It is most closely associated with the Sellick maneuver and rapid sequence intubation.

For respiratory therapists, the key is to understand both the purpose and the limitations of the technique. Proper hand placement, controlled pressure, clear communication, and readiness to adjust or release pressure are essential.

Cricoid pressure should never interfere with oxygenation, ventilation, or successful tube placement. It is one part of safe airway management, not a replacement for careful assessment and skilled clinical judgment.