Oxygen desaturation and time burden during tracheobronchial endoscopy for suspected foreign body in toddlers

Area of Science:

• Pediatric Anesthesiology
• Respiratory Medicine
• Medical Technology Assessment

Background:

• Tracheobronchial endoscopy under general anesthesia for foreign body aspiration in toddlers frequently leads to acute hypoxemia.
• Accurate quantification of intraoperative hypoxemia is crucial for identifying and managing high-risk pediatric patients.
• Existing methods may not fully capture the severity of desaturation events during these procedures.

Purpose of the Study:

• To explore the utility of the hypoxic burden approach for quantifying intraoperative hypoxemia during pediatric tracheobronchial endoscopy.
• To identify risk factors associated with a high hypoxic burden in toddlers undergoing this procedure.
• To correlate hypoxic burden with clinical outcomes such as postoperative ventilation and hospital stay duration.

Main Methods:

• Retrospective analysis of 96 tracheobronchial endoscopies in children ≤36 months for suspected foreign body aspiration (September 2015-September 2018).
• Calculation of hypoxic burden as the area under the SpO2/time curve below 90%.
• Multivariable analysis to identify risk factors for high hypoxic burden and its association with clinical outcomes.

Main Results:

• 58% of procedures involved at least one SpO2 value <90%.
• Median hypoxic burden was 25 [%.min].
• Factors associated with reduced high hypoxic burden risk included initial admission to general hospitals and airway anesthesia with topical lidocaine. High hypoxic burden correlated with increased need for postoperative invasive ventilation and longer hospital stays (>24h). No neurological sequelae were observed.

Conclusions:

• The hypoxic burden approach effectively quantifies intraoperative hypoxemia during tracheobronchial endoscopy in toddlers.
• Topical lidocaine and initial general hospital admission are associated with a lower risk of significant hypoxemia.
• High hypoxic burden is a predictor of adverse postoperative outcomes, including increased need for ventilation and prolonged hospitalization.