Suction Assisted Laryngoscopy Airway Decontamination (SALAD)

Reviewed and revised 5 April 2015

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

1. 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).
2. Use of the rigid suction catheter as a tongue depressor/lifter to permit the laryngoscope blade perfect position on the first attempt
3. 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
4. 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
5. 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

References and Links

FOAM and web resources

• Video of the SALAD technique by James Du Canto (2015)