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Apneic oxygenation with low-flow oxygen cannula for rapid sequence induction and intubation in pediatric patients: a
Naiyana Aroonpruksakul1, Peerapong Sangsungnern1, Taniga Kiatchai1
1Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Apneic oxygenation via nasal cannula did not reduce hypoxemia during pediatric rapid sequence induction. This study found no significant difference in hypoxemia incidence between the apneic oxygenation and classical groups.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Respiratory Physiology
Background:
- Rapid sequence induction and intubation (RSII) aims to prevent pulmonary aspiration but risks hypoxemia.
- Apneic oxygenation (ApOx) may prolong safe apnea and decrease hypoxemia in adults.
- The effectiveness of ApOx in pediatric RSII requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of ApOx using low-flow nasal cannulas in minimizing hypoxemia during pediatric RSII.
- To compare hypoxemia incidence in children undergoing RSII with or without ApOx.
Main Methods:
- A prospective, single-blind, randomized controlled trial involving 64 pediatric patients (0-7 years, ASA physical status 1-3).
- Patients were randomized to receive ApOx via age-adjusted low-flow nasal cannula or undergo classical RSII without oxygen supplementation.
- The primary outcome was the incidence of hypoxemia, defined as SpO2 ≤92%.
Main Results:
- The incidence of hypoxemia was 25% in both the ApOx group (8/32) and the classical RSII group (8/32) (P=1.000).
- Median time to desaturation was similar between groups (29.5s vs. 35s, P=0.527).
- Lowest SpO2 and time to successful intubation showed no statistically significant differences between groups.
Conclusions:
- Apneic oxygenation with age-adjusted low-flow nasal cannulas was not effective in reducing hypoxemia during pediatric rapid sequence induction in this study.
- The findings suggest that ApOx via nasal cannula may not be beneficial for preventing hypoxemia in this specific pediatric population and procedure.
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 (SpO2) ≤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 SpO2 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.
Trial Registration:
Thai Clinical Trials Registry TCTR20210802002.
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