Hypoxia is a common complication during the emergent intubation of children. Several
approaches may help avoid hypoxia, including semiupright patient positioning, adequate
preoxygenation, and nasal cannula apneic oxygenation. Delayed sequence intubation
(DSI) is a strategy to facilitate preoxygenation when standard efforts using supplemental
oxygen with nonrebreather (NRB) mask are not successful. In DSI, the sedative agent
ketamine is administered to facilitate effective preoxygenation via NRB mask or continuous
positive airway pressure (CPAP), followed by the delayed administration of a neuromuscular
blocking agent once adequate preoxygenation has been achieved. A recent prospective,
observational, multicenter study of adults demonstrated that DSI using ketamine facilitated
increased oxygenation saturations during preoxygenation in adults [
[1]
]. To date there have only been 2 descriptions of the use of pediatric DSI in the literature,
both in normotensive patients [
2
,
3
]. We present the successful use of ketamine for DSI in 2 critically ill hypoxic children
in shock requiring emergent intubation. Delayed sequence intubation is a strategy
that should be considered for children who are not able to be preoxygenated for intubation
using conventional strategies.To read this article in full you will need to make a payment
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References
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Article Info
Publication History
Published online: November 19, 2015
Accepted:
November 17,
2015
Received:
November 13,
2015
Footnotes
☆Conflicts of interest and source of funding: No conflicts of interest declared. No outside funding sources.
Identification
Copyright
© 2015 Elsevier Inc. All rights reserved.
