Apneic oxygenation reduces hypoxemia during endotracheal intubation in the pediatric emergency department

Vukovic, Adam A.; Hanson, Holly R; Murphy, Shelley; Mercurio, Danielle; Sheedy, Craig A.; Arnold, Donald H.

doi:10.1016/j.ajem.2018.04.039

Cited by 27 publications

(38 citation statements)

References 33 publications

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“…In subgroup analysis, ApOx was highly effective in intubations for nonrespiratory indications (OR ¼ 0.21, 95% CI: 0.07-0.60), while it was not effective in tracheal intubations (TIs) for respiratory indications (OR ¼ 1.59, 95% CI: 0.87-2.89). This is in keeping with findings previously suggested in adult studies and may reflect respiratory shunt physiology, 15 although the use of high flow oxygen or NIV prior to intubation of respiratory patients was not described. ApOx was not reported to be associated with any adverse events.…”

Section: Included Studiessupporting

confidence: 90%

“…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%

“…Vukovic et al conducted a single center pre-post study of ApOx in a tertiary pediatric ED. 15 One hundred forty-nine patients were included (59 pre-ApOx and 90 ApOx). Oxygen flow rates were age based as described in ►Table 1.…”

Section: Included Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Apneic Oxygenation for Pediatric Endotracheal Intubation: A Narrative Review

Scott

Chua

Mitchell

et al. 2019

J Pediatr Intensive Care

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Section: Included Studiessupporting

confidence: 90%

Section: Literature Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Apneic Oxygenation for Pediatric Endotracheal Intubation: A Narrative Review

Scott

Chua

Mitchell

et al. 2019

J Pediatr Intensive Care

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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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“…Although it has been reported that RSI improves the success rate in children similar to adults, intubation without RSI (e.g., awake intubation with preserved spontaneous respiration) is undertaken more frequently compared to adults . Additionally, apneic oxygenation was associated with a lower risk of hypoxemia during intubation of children in the ED …”

Section: Special Circumstance: Childrenmentioning

confidence: 99%

Advancing emergency airway management practice and research

Goto

Hagiwara

et al. 2019

Acute Medicine & Surgery

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Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.

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Apneic oxygenation reduces hypoxemia during endotracheal intubation in the pediatric emergency department

Cited by 27 publications

References 33 publications

Apneic Oxygenation for Pediatric Endotracheal Intubation: A Narrative Review

Apneic Oxygenation for Pediatric Endotracheal Intubation: A Narrative Review

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

Advancing emergency airway management practice and research

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