Abstract
Background
Apneic oxygenation (AO) has been evaluated in adult patients as a means of reducing
hypoxemia during endotracheal intubation (ETI). While less studied in pediatric patients,
its practice has been largely adopted.
Objective
Determine association between AO and hypoxemia in pediatric patients undergoing ETI.
Methods
Observational study at an urban, tertiary children's hospital emergency department.
Pediatric patients undergoing ETI were examined during eras without (January 2011–June
2011) and with (August 2014–March 2017) apneic oxygenation. The primary outcome was
hypoxemia, defined as pulse oximetry (SpO2) < 90%. The χ2 and Wilcoxon rank-sum tests examined differences between cohorts. Multivariable regression
models examined adjusted associations between covariates and hypoxemia.
Results
149 patients were included. Cohorts were similar except for greater incidence of altered
mental status in those receiving AO (26% vs. 7%, p = 0.03). Nearly 50% of the pre-AO cohort experienced hypoxemia during ETI, versus
<25% in the AO cohort. Median [IQR] lowest SpO2 during ETI was 93 (69, 99) for pre-AO and 100 [95, 100] for the AO cohort (p < 0.001). In a multivariable logistic regression model, hypoxemia during ETI was
associated with AO (aOR 0.3, 95% confidence interval [CI] 0.1–0.8), increased age
(for 1 year, aOR 0.8, 95% CI 0.7–1.0), lowest SpO2 before ETI (for 1% increase, aOR 0.9, 95% CI 0.8–1.0), and each additional intubation
attempt (aOR 4.0, 95% CI 2.2–7.2).
Conclusions
Apneic oxygenation is an easily-applied intervention associated with decreases in
hypoxemia during pediatric ETI. Nearly 50% of children not receiving AO experienced
hypoxemia.
Abbreviations:
AO (apneic oxygenation), ETI (endotracheal intubation), PED (pediatric emergency department)Keywords
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Article Info
Publication History
Published online: April 18, 2018
Accepted:
April 17,
2018
Received in revised form:
April 17,
2018
Received:
March 12,
2018
Footnotes
☆Meetings: Poster presentation at Southeastern Regional Meeting for the Society of Academic Emergency Medicine, Jacksonville, FL, February 10–11, 2017; Pediatric Academic Societies Annual Meeting, San Francisco, CA, May 6–9, 2017.
☆This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
