Suction Assisted Laryngoscopy Airway Decontamination (SALAD)
OVERVIEW
Suction Assisted Laryngoscopy Airway Decontamination (SALAD) is the term coined by Jim Du Canto and colleagues for a suction technique used to preventing airway soiling during laryngoscopy when there is profuse regurgitation
TECHNIQUE
The technique, as described by Jim Du Canto, involves the following steps:
- Oral decontamination followed by laryngoscope blade insertion hugging the surface of the tongue (anteriorly) so as to avoid submerging the illumination/optics module in vomitus (thank you to Seth Manoach M.D. for this vital detail).
- Use of the rigid suction catheter as a tongue depressor/lifter to permit the laryngoscope blade perfect position on the first attempt
- Further decontamination of the hypopharynx, followed by insertion of the rigid suction catheter into the proximal esophagus to serve as a continued drain of emesis
- Repositioning of the suction catheter to the left corner of the patient’s mouth facilitated by a slight withdrawal and reinsertion of the laryngoscope blade to permit this transit. The laryngoscope blade will now effectively pin the suction catheter in place with this maneuver, as the left portion of the blade contacts the right portion of the suction catheter, securing it in place and holding it out of the path of endotracheal intubation
- Slight rotation of the laryngoscope blade leftward 30 degrees to further open a channel for endotracheal tube passage through the pharynx and into the larynx. Inflation of the endotracheal tube cuff and suctioning of the tracheal tube and trachea prior to ventilation to avoid spreading any aspirated material
DEMONSTRATION VIDEO
Jim Du Canto demonstrating the SALAD technique:
References and Links
CCC Airway Series
Emergencies: Can’t Intubate, Can’t Intubate, Can’t Oxygenate (CICO), Laryngospasm, Surgical Cricothyroidotomy
Conditions: Airway Obstruction, Airway in C-Spine Injury, Airway mgmt in major trauma, Airway in Maxillofacial Trauma, Airway in Neck Trauma, Angioedema, Coroner’s Clot, Intubation of the GI Bleeder, Intubation in GIH, Intubation, hypotension and shock, Peri-intubation life threats, Stridor, Post-Extubation Stridor, Tracheo-esophageal fistula, Trismus and Restricted Mouth Opening
Pre-Intubation: Airway Assessment, Apnoeic Oxygenation, Pre-oxygenation
Paediatric: Paediatric Airway, Paeds Anaesthetic Equipment, Upper airway obstruction in a child
Airway adjuncts: Intubating LMA, Laryngeal Mask Airway (LMA)
Intubation Aids: Bougie, Stylet, Airway Exchange Catheter
Intubation Pharmacology: Paralytics for intubation of the critically ill, Pre-treatment for RSI
Laryngoscopy: Bimanual laryngoscopy, Direct Laryngoscopy, Suction Assisted Laryngoscopy Airway Decontamination (SALAD), Three Axis Alignment vs Two Curve Theory, Video Laryngoscopy, Video Laryngoscopy vs. Direct
Intubation: Adverse effects of endotracheal intubation, Awake Intubation, Blind Digital Intubation, Cricoid Pressure, Delayed sequence intubation (DSI), Nasal intubation, Pre-hospital RSI, Rapid Sequence Intubation (RSI), RSI and PALM
Post-intubation: ETT Cuff Leak, Hypoxia, Post-intubation Care, Unplanned Extubation
Tracheostomy: Anatomy, Assessment of swallow, Bleeding trache, Complications, Insertion, Insertion timing, Literature summary, Perc. Trache, Perc. vs surgical trache, Respiratory distress in a trache patient, Trache Adv. and Disadv., Trache summary
Misc: Airway literature summaries, Bronchoscopic Anatomy, Cuff Leak Test, Difficult airway algorithms, Phases of Swallowing
FOAM and web resources
- EMCrit Podcast 196 – Having a Vomit SALAD with Dr. Jim DuCanto – Airway Management Techniques during Massive Regurgitation, Emesis, or Bleeding
- Jellybean 051. Jim DuCanto interview
- Video of the SALAD technique by James Du Canto (2016)
Journal articles
- Ducanto J, Serrano KD, Thompson RJ. Novel Airway Training Tool that Simulates Vomiting: Suction-Assisted Laryngoscopy Assisted Decontamination (SALAD) System. West J Emerg Med. 2017;18(1):117-120. [pubmed] [article]
- Jensen M, Louka A, Barmaan B. Effect of Suction Assisted Laryngoscopy Airway Decontamination (SALAD) Training on Intubation Quality Metrics. Air Med J. 2019;38(5):325. [pubmed]
- Lin LW, Huang CC, Ong JR, Chong CF, Wu NY, Hung SW. The suction-assisted laryngoscopy assisted decontamination technique toward successful intubation during massive vomiting simulation: A pilot before-after study. Medicine (Baltimore). 2019;98(46):e17898. [pubmed] [article]
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
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