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An alternative oxygen delivery system for infants and children in the post-anaesthesia care unit
D Amar1, L E Brodman, S A Winikoff
1Department of Anesthesiology, Montefiore Medical Center, Bronx, NY 10467.
Insights
The "hose" method for oxygen delivery showed 100% compliance in children post-anesthesia, unlike the standard face mask. This effective method improved oxygen saturation (SaO2) in pediatric patients in the post-anesthesia care unit (PACU).
Area of Science:
- Pediatric Anesthesiology
- Respiratory Care
- Postoperative Management
Background:
- Children recovering from anesthesia often require oxygen supplementation in the post-anesthesia care unit (PACU).
- Standard face masks have shown high rejection rates in pediatric patients, potentially compromising oxygenation.
- Postoperative hypoxemia is a risk in children, particularly those with pre-existing cardiopulmonary conditions.
Purpose of the Study:
- To compare the compliance of a novel 'hose' oxygen delivery method versus a standard face mask in pediatric patients.
- To evaluate the efficacy of the 'hose' method in improving oxygen saturation (SaO2) in children at varying risks of hypoxemia.
- To assess the effectiveness of the 'hose' method in the PACU setting.
Main Methods:
- A randomized controlled trial involving 66 infants and children (mean age 2.3 years) in the PACU.
- Continuous monitoring of SaO2 using a pulse oximeter for 30 minutes upon arrival.
- Patients were randomized to receive oxygen via either a face mask or the 'hose' method.
Main Results:
- The 'hose' method demonstrated 100% compliance, whereas the face mask was rejected by over 80% of patients.
- Oxygen supplementation with the 'hose' method resulted in significantly higher SaO2 measurements compared to baseline room air.
- Patients with pre-existing cardiopulmonary disease had a higher incidence of desaturation (20%) upon PACU arrival compared to those without (2.1%).
Conclusions:
- The 'hose' method is associated with high patient compliance and is effective for oxygen supplementation in pediatric PACU patients.
- This method successfully increases SaO2 in children at both low and high risk for developing postoperative hypoxemia.
- The 'hose' method offers a viable alternative to face masks for improving oxygenation in the pediatric PACU.
Abstract:
This randomized controlled trial compared the compliance of a blow-by oxygen method with the standard face mask by children recovering from anaesthesia. The rate at which a face mask was rejected when applied to infants and children in PACU was compared with that of a proposed "hose" method. The efficacy of the "hose" as a method of oxygen supplementation in children at low and high risk for developing postoperative hypoxaemia was also compared with the face mask. Using a Nellcor N-200 pulse oximeter, 66 infants and children (mean age 2.3 yr, range 2 mo-6 yr) were continuously monitored for 30 min upon arrival in the PACU. Patients were randomized to receive oxygen supplementation with either the face mask or the proposed "hose" method. The results showed a greater than 80 per cent rejection of the face mask in contrast to 100 per cent compliance with the "hose" method. The SaO2 measurements following 5, 15 and 30 min of O2 supplementation with the hose were all significantly higher than the SaO2 measurements obtained on room air upon arrival to the PACU. Patients with pre-existing cardiopulmonary disease had a 20 per cent incidence of arterial oxygen desaturation upon arrival to the PACU versus 2.1 per cent of patients with no pre-existing disease. It is concluded that the "hose" is associated with high patient compliance and is effective in the PACU in increasing the SaO2 in children at low or high risk of developing postoperative hypoxaemia.