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Published on: December 22, 2016
Effect of high-flow nasal and buccal oxygenation on safe apnea time in children with open mouth: A randomized
Sang-Hwan Ji1, Jung-Bin Park1, Pyoyoon Kang1
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Insights
High-flow nasal oxygenation (HFNO) is more effective than buccal oxygenation (BO) for prolonging safe apnea time in pediatric patients with open mouths. HFNO achieved a 100% success rate, while BO had a 76% success rate.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
- Critical Care Medicine
Background:
- High-flow nasal oxygenation (HFNO) and buccal oxygenation (BO) can prolong apnea duration with adequate oxygen saturation.
- Previous studies focused on mouth-closed scenarios or obese adults.
- The efficacy of these methods in pediatric patients with open mouths during apnea was unexplored.
Purpose of the Study:
- To compare the effectiveness of HFNO and BO in prolonging acceptable apnea time in pediatric patients with their mouths open.
- To evaluate the safety and efficacy of oxygenation strategies during apneic periods in children.
Main Methods:
- A randomized study involving 38 pediatric patients (0-10 years) allocated to HFNO or BO groups.
- Manual ventilation to achieve 90% expiratory oxygen concentration, followed by a paused ventilation period with an open mouth.
- HFNO group received 2 L·min⁻¹·kg⁻¹, BO group received 0.5 L·min⁻¹·kg⁻¹; success defined by reaching target apnea time without SpO2 dropping below 92%.
Main Results:
- High-flow nasal oxygenation demonstrated a 100% success rate in prolonging safe apnea time.
- Buccal oxygenation achieved a success rate of 76%, significantly lower than HFNO (p=0.04).
- No significant differences were observed in oxygen reserve index, CO2 levels, or pulse oximetry between the groups.
Conclusions:
- High-flow nasal oxygenation is superior to buccal oxygenation for maintaining oxygen saturation during apnea in pediatric patients with open mouths.
- HFNO is an effective strategy for apneic oxygenation in this population.
- Buccal oxygenation can be considered a viable alternative if HFNO is unavailable.
Background:
High-flow nasal oxygenation is reported to prolong duration of apnea while maintaining adequate oxygen saturation with the mouth closed. Also, buccal oxygenation is known to have similar effects in obese adults. We compared the effect of these two methods on prolongation of acceptable apnea time in pediatric patients with their mouth open.
Methods:
Thirty-eight patients, aged 0-10 years were randomly allocated to either the high-flow nasal oxygenation group (n = 17) or the buccal oxygenation group (n = 21). After induction of anesthesia including neuromuscular blockade, manual ventilation was initiated until the expiratory oxygen concentration reached 90%. Subsequently, ventilation was paused, and the patient's head was extended, and mouth was opened. The HFNO group received 2 L·min-1·kg-1 of oxygen, and the BO group received 0.5 L·min-1·kg-1 of oxygen. We set a target apnea time according to previous literature. When the apnea time reached the target, we defined the case as "success" in prolongation of safe apnea time and resumed ventilation. When the pulse oximetry decreased to 92% before the target apnea time, it was recorded as "failure" and rescue ventilation was given.
Results:
The success rate of safe apnea prolongation was 100% in the high-flow nasal oxygenation group compared to 76% in the buccal oxygenation group (p = .04). Oxygen reserve index, end-tidal or transcutaneous carbon dioxide partial pressure, and pulse oximetry did not differ between groups.
Conclusion:
High-flow nasal oxygenation is effective in maintaining appropriate arterial oxygen saturation during apnea even in children with their mouth open and is superior to buccal oxygenation. Buccal oxygenation may be a good alternative when high-flow nasal oxygenation is not available.
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