Apneic Oxygenation for Pediatric Endotracheal Intubation: A Narrative Review

Scott, Alice; Chua, Olivia; Mitchell, William; Vlok, Ruan; Melhuish, Thomas; White, Leigh

doi:10.1055/s-0039-1678552

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…Multiple studies from pediatric emergency departments have demonstrated that in combination with other quality improvement measures, routine use of passive oxygenation during endotracheal intubation reduces the incidence of adverse events . Given this evidence together with the known increases in safe apneic times, the PeDI Collaborative, which is the group behind the PeDI‐R, has recommended the use of a difficult airway bundle checklist (Figure ), which includes the use of supplemental oxygen during attempts at tracheal intubation.…”

Section: Oxygen Deliverymentioning

confidence: 99%

Emerging trends, techniques, and equipment for airway management in pediatric patients

Stein

Park

Kovatsis

2020

Pediatric Anesthesia

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Pediatric patients present unique anatomic and physiologic considerations in airway management, which impose significant physiologic limits on safe apnea time before the onset of hypoxemia and subsequent bradycardia. These issues are even more pronounced for the pediatric difficult airway. In the last decade, the development of pediatric sized supraglottic airways specifically designed for intubation, as well as advances in imaging technology such that current pediatric airway equipment now finally rival those for the adult population, has significantly expanded the pediatric anesthesiologist's tool kit for pediatric airway management. Equally important, techniques are increasingly implemented that maintain oxygen delivery to the lungs, safely extending the time available for pediatric airway management. This review will focus on emerging trends and techniques using existing tools to safely handle the pediatric airway including videolaryngoscopy, combination techniques for intubation, techniques for maintaining oxygenation during intubation, airway management in patients at risk for aspiration, and considerations in cannot intubate cannot oxygenate scenarios.

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Section: Oxygen Deliverymentioning

confidence: 99%

Emerging trends, techniques, and equipment for airway management in pediatric patients

Stein

Park

Kovatsis

2020

Pediatric Anesthesia

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“…Regarding the profile of patients who are intubated in pediatric emergencies, this is data that varies greatly depending on the center studied [3][4][16][17][18][21][22][23] , and there are few recent studies with an adequate sample. In this review, the study carried out by Céspeez et al 19 identified that the main indication for intubation was cardiopulmonary failure, with this and respiratory failure also being associated with greater difficulty in carrying out the procedure.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2024

Resid. Pediatr.

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Objectives: To identify up-to-date information that contributes to increasing the progress of rapid sequence intubation (RSI) in pediatric emergencies. Methods: This is an integrative literature review that used the keywords "Rapid Sequence Induction and Intubation", "Intubation, Intratracheal" and "Pediatric Emergency Medicine" in the Scielo, PubMed and Virtual Health Library databases, using, after applying the inclusion and exclusion criteria, the content analysis for discussion. Results: We found 9 articles that were later discussed. Conclusions: Many health professionals do not correctly indicate medications during and after RSI in pediatric emergencies, and educational interventions aimed at correcting this failure are beneficial. An accurate epidemiological profile of RSI in pediatric emergencies cannot yet be established. The best way to collect data in studies involving RSI is through video recording. Interventions aimed at reducing the time spent during orotracheal tube insertion may more effectively reduce the total apnea time during RSI. The use of apneic oxygenation and fractional expired oxygen (FeO2) analysis may have some benefits in RSI.

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“…This technique has increased in popularity over the last ten years due to its ability to reduce desaturation during intubation in the ED and ICU, and in healthy patients undergoing elective surgery in adult studies (8,18,19). This technique has also been implemented in obesity, obstetrics, and pediatrics (16,20). In a small number of pediatric studies in a non-RSII condition, ApOx could prolong safe apneic time and decrease the incidence of hypoxemia (21)(22)(23)(24).…”

Section: Introductionmentioning

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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Apneic Oxygenation for Pediatric Endotracheal Intubation: A Narrative Review

Cited by 8 publications

References 18 publications

Emerging trends, techniques, and equipment for airway management in pediatric patients

Emerging trends, techniques, and equipment for airway management in pediatric patients

Untitled

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

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