Fasiha Saeed, MD, FAAP
Pediatric Intensivist
Advocate Children's Hospital
Park Ridge, Illinois
Disclosure information not submitted.
Ramona Donovan, MS, RD, CCRC
Research Program Manager, Research Clinical Research Coordinator
Advocate Children's Hospital
PARK RIDGE, Illinois, United States
Disclosure information not submitted.
Yi Li, PhD
Sr. Coordinator, Patient Centered Outcomes Research
Advocate Center for Pediatric Research, Research Institute, United States
Disclosure information not submitted.
Cheryl Lefaiver, PhD, RN, CCRP
Director, Advocate Center for Pediatric Research
Advocate Medical Group, United States
Disclosure information not submitted.
William Tsai, MD
Pediatric Critical Care Medicine
Denver Health and Hospital Authority, United States
Disclosure information not submitted.
Title: Apneic Oxygenation in the Pediatric Intensive Care Unit
Introduction: Apneic Oxygenation (AO) has been used frequently in the adult and recently pediatric population during tracheal intubation (TI) to help prolong the safe time before oxygen desaturation. Desaturation during TI places patients at greater risk for complications. The benefit of AO in the pediatric population has yet to be established. Randomized trials in the pediatric intensive care unit (PICU) are limited. We hypothesized that pediatric patients requiring emergent intubation in the PICU would have reduced frequency and delayed onset of desaturation with apneic oxygenation compared to standard practice.
Methods: Patients < 18 years old admitted to our PICU requiring emergent intubation with premedication including a paralytic were enrolled in this study. Patients were randomized in blocks of 10 and stratified into age groups of < 2 and ≥ 2 years placed on 3 liters per minute (LPM) nasal cannula (NC) and 5LPM NC respectively. We measured time to desaturation of ≥ 5% from starting saturation. The first two attempts were included for patients with starting saturation >90% to compare median time to desaturation between groups. Mann-Whitney U tests, Chi-square tests and Fisher’s Exact tests were used for group comparisons as appropriate for the level of measurements. A 2-sided p value < 0.05 is considered statistically significant.
Results: A total of 41 patients (median age 24 months, 49% female, 30% Hispanic) requiring emergent TI were enrolled between 12/2017- 2/2020, with 20 in the AO and 21 in the standard care (SC) group. The groups are similar in demographics and baseline characteristics. Frequency of desaturation did not differ between groups (4, 20%, in AO and 3,15%, in SC, p =1). Of all 11 attempts ending with ≥ 5% desaturation (6 AO and 5 SC) there was no difference in the median time to desaturation between groups (AO 31 seconds, ranged 19 – 118, vs. SC 86, 65 – 109, p =0.18).
Conclusion: There was no significant difference in the frequency of or duration of time to desaturation in pediatric patients using AO versus standard care requiring TI in our PICU. Block randomization was feasible and could be utilized when developing a larger multicenter randomized control trial for the use of apneic oxygenation during emergent TI in the PICU.