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
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
Jim Du Canto demonstrating the SALAD technique:
References and Links
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)
- 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]
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.