Abstract
Background
Apneic oxygenation is the delivery of oxygen to the nasopharynx during intubation.
It may mitigate the risk of oxyhemoglobin desaturation but has not been well-studied
in children.
Methods
We conducted a retrospective, observational study of patients undergoing rapid sequence
intubation (RSI) in a pediatric emergency department. We compared patients who received
apneic oxygenation, delivered via simple nasal cannula at age-specific flow rates,
to patients who did not receive apneic oxygenation. The main outcome was occurrence
of oxyhemoglobin desaturation during RSI, defined as oxyhemoglobin saturation dropping
to <90% at any time after the administration of paralytic medication and before the
endotracheal tube was secured. Data were analyzed using logistic regression, with
groups as a fixed effect and patients' age and number of attempts as covariates.
Results
Data were collected for 305 of 323 patients who underwent RSI over a 49 month period.
Oxyhemoglobin desaturation occurred for 50 patients when apneic oxygenation was used
(22%, 95% CI 17% to 28%) and 11 patients without apneic oxygenation (14%, 95% CI 7%
to 24%; p > 0.05). There was no difference in the median duration of desaturation or depth
of desaturation for the apneic oxygenation group (52 s, 71%) compared to the group
without apneic oxygenation (65 s, 79%; p > 0.05). Controlling for covariates, apneic oxygenation was not associated with a
lower risk of oxyhemoglobin desaturation, time to desaturation, or depth/duration
of desaturation episodes.
Conclusions
In an observational, video-based study of pediatric patients, apneic oxygenation was
not associated with a lower risk of oxyhemoglobin desaturation during RSI.
Keywords
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Article Info
Publication History
Published online: October 18, 2018
Accepted:
October 17,
2018
Received in revised form:
October 9,
2018
Received:
July 31,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
