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Apnoeic oxygenation during paediatric intubation: A systematic review
Shane George1,2,3, Megan Wilson4,5, Susan Humphreys3,6
1Departments of Emergency Medicine and Children's Critical Care, Gold Coast University Hospital, Southport, QLD, Australia.
Frontiers in Pediatrics
|December 8, 2022
Summary
Apnoeic oxygenation during pediatric intubation significantly reduces hypoxemia. While promising in operating theaters, its effectiveness in emergency settings requires further research for optimal techniques.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Respiratory Physiology
Background:
- Airway management in children is critical.
- Hypoxemia during pediatric intubation is a significant concern.
- Apnoeic oxygenation is a technique to maintain oxygenation during airway manipulation.
Purpose of the Study:
- To review the evidence on apnoeic oxygenation during pediatric intubation.
- To assess its impact on hypoxemia, intubation success, and adverse events.
- To identify areas for future research.
Main Methods:
- Systematic review of multiple databases (PubMed, Medline, CINAHL, EMBASE, Cochrane Library).
- Inclusion of studies on pediatric intubation using any apnoeic oxygenation method.
- Data extraction and risk of bias assessment by independent reviewers.
Main Results:
- Fourteen studies (N=2442) met eligibility criteria.
- Apnoeic oxygenation reduced hypoxemia in randomized controlled trials and operating theatre studies (RR: 0.34, 95% CI: 0.24-0.47; RR: 0.27, 95% CI: 0.11-0.68).
- Studies in ED and PICU had lower quality and heterogeneity; first-attempt intubation success data were inconsistent.
Conclusions:
- Growing evidence supports apnoeic oxygenation in pediatric intubation.
- Humidified high-flow oxygen shows promise, particularly in operating theaters.
- Further research is needed to optimize flow rates and delivery techniques, especially for emergency intubations.
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