Apneic Oxygenation during Rapid Sequence Intubation in Critically Ill Children

Mortimer, Todd; Burzynski, Jeff; Kesselman, Murray; Vallance, Jeff K.; Hansen, Gregory

doi:10.1055/s-0035-1568149

Cited by 8 publications

(6 citation statements)

References 9 publications

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“…The oxygen flow rate used in this pediatric study was according to WHO recommendation and as follows (25) (12,(21)(22)(23)(24)(26)(27)(28)(29). Future physiologic studies are needed to determine the oxygen flow rate in children that is equivalent to nasal cannula 15 LPM in adults, or the minimal flow required to meet metabolic demand.…”

Section: Discussionmentioning

confidence: 99%

Apneic oxygenation with low-flow oxygen cannula for rapid sequence induction and intubation in pediatric patients: a randomized-controlled trial

Aroonpruksakul¹,

Sangsungnern²,

Kiatchai³

2022

Transl Pediatr

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Background: Classical rapid sequence induction and intubation (RSII) is used to reduce pulmonary aspiration, but it increases the risk of hypoxemia. Apneic oxygenation (ApOx) has been studied to prolong safe apneic time, and to decrease the incidence of hypoxemia in adults. The aim of this study was to investigate the effectiveness of ApOx via low-flow nasal cannula to reduce the incidence of hypoxemia in pediatric rapid sequence induction.Methods: This prospective single-blind randomized controlled trial included patients aged 0-7 years, American Society of Anesthesiologists (ASA) physical status 1 to 3, who underwent elective or emergency surgery under general anesthesia with rapid sequence induction during February 2020 to March 2021.Participants were randomized to the ApOx group or the classical rapid sequence induction group. The ApOx group received oxygen flow via regular nasal cannula, as follows: 1 liter per minute (LPM) in age 0-1 month, 2 LPM in age 1-12 months, and 4 LPM in age 1-7 years. The classical group did not receive oxygen supplementation during intubation. The primary outcome was the incidence of hypoxemia, defined as oxygen saturation (SpO 2 ) ≤92%.Results: Sixty-four participants were recruited. The incidence of hypoxemia in both groups was 8 of 32 participants (25%) (P=1.000). Among desaturated patients, the median time to desaturation was 29.5 and 35 seconds in the ApOx and classical groups, respectively (P=0.527). The median lowest SpO 2 was 91% and 88.5% in the ApOx and classical groups, respectively (P=0.079). In non-desaturated patients, the median time to successful intubation was 40.5 and 35.5 seconds in the ApOx and classical groups, respectively (P=0.069). Conclusions:In this small sample study, ApOx using age-adjusted low-flow nasal cannula was ineffective for reducing the incidence of hypoxemia in pediatric RSII.

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Section: Discussionmentioning

confidence: 99%

Apneic oxygenation with low-flow oxygen cannula for rapid sequence induction and intubation in pediatric patients: a randomized-controlled trial

Aroonpruksakul¹,

Sangsungnern²,

Kiatchai³

2022

Transl Pediatr

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“…Following on from Levitan’s use of standard nasal cannulae for apnoeic oxygenation in adults [2], a similar approach has been adopted during rapid sequence intubation in paediatric emergency departments. Although there is no high‐quality evidence supporting this intervention, observational studies have reported oxygen insufflation via standard nasal cannulae at flow rates up to 15 l.min −1 as part of routine care during rapid sequence intubation [21–25]. Children receiving apnoeic oxygenation typically experienced less arterial oxygen desaturation when compared with children whose tracheas were intubated in those departments before implementation of the technique (Table 1).…”

Section: Apnoeic Oxygenation Via Standard Nasal Cannulaementioning

confidence: 99%

Apnoeic oxygenation in paediatric anaesthesia: a narrative review

Lyons

Callaghan

2020

Anaesthesia

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Apnoeic oxygenation refers to oxygenation in the absence of any patient or ventilator effort to move the lungs. This phenomenon was first described in humans in the mid-20th century but has seen renewed interest in the last decade following the demonstration of apnoeic oxygenation with low-flow, and subsequently high-flow, nasal oxygen. This narrative review summarises our understanding of apnoeic oxygenation in the paediatric population. We examine the evidence supporting oxygenation via tracheal tube, modified laryngoscopes and nasal cannulae. The evidence for prolongation of safe apnoea time at induction of anaesthesia is also appraised. We explore the capacity for carbon dioxide clearance, flow rate selection with high-flow nasal oxygen and complications associated with the technique. It remains uncertain whether apnoeic oxygenation in paediatric patients results in a meaningful clinical benefit compared with standard care for outcomes such as the number of tracheal intubation attempts or the incidence of hypoxaemia. In particular, the role of apnoeic oxygenation in paediatric difficult airway management is unclear as this has not been the targeted focus of any published research to date.

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“…A review of five databases (SCOPUS, Web of Science, CINAHL, Medline, and PubMed) for primary studies on the use of pediatric ApOx in endotracheal intubation up to and including August 2018 yielded eight studies for inclusion [9][10][11][12][13][14][15][16] (►Table 1). Articles were included if they assessed the performance of ApOx during intubation with that of a control group in a pediatric population.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Mortimer et al published a prospective case series of 44 critically ill children receiving rapid sequence intubation (RSI) with ApOx in a pediatric ICU or ED. 12 All patients were younger than 18 years of age and required urgent airway management. Patients were excluded if they had cardiac shunt physiology or hypoxemia < 90% prior to the administration of a neuromuscular blocking agent.…”

Section: Included Studiesmentioning

confidence: 99%