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Oxygen Supplementation in Pediatric Sedation: Prospective, Multicenter, Randomized Controlled Trial
Ji-Hyun Lee1, Hyun Jung Ko2, Jung-Bin Park1
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Anesthesiology
|April 11, 2025
Summary
Routine oxygen supplementation, particularly low-flow nasal cannula oxygen, effectively prevents hypoxemia in sedated children. This method is a practical and accessible choice for pediatric procedural sedation.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
- Critical Care Medicine
Background:
- Children undergoing moderate to deep sedation are at risk for hypoxemia due to unique physiological characteristics.
- Optimal oxygen administration strategies during pediatric sedation remain unclear.
- This study investigates the efficacy of low-flow versus high-flow nasal cannula oxygen supplementation.
Purpose of the Study:
- To evaluate the effectiveness of oxygen supplementation in preventing hypoxemia in children undergoing moderate to deep sedation.
- To compare the incidence of hypoxemia between no oxygen, low-flow oxygen, and high-flow oxygen groups.
- To assess secondary outcomes including severe hypoxemia, rescue interventions, and sedation-related complications.
Main Methods:
- A prospective, multicenter randomized controlled trial involving children under 18 years undergoing sedation.
- Participants were randomized into three groups: control (no oxygen), low-flow oxygen (2-6 L/min), and high-flow oxygen (2 L/kg/min, 50% FiO2).
- Primary outcome was hypoxemia (SpO2 ≤ 95% for >5s); secondary outcomes included SpO2 < 90%, rescue interventions, and complications.
Main Results:
- Hypoxemia incidence was significantly lower in both low-flow (7.2%) and high-flow (1.2%) groups compared to the control group (27.6%) (P < 0.001).
- While high-flow oxygen showed a trend towards lower hypoxemia than low-flow, it was not statistically significant (P = 0.078).
- Rescue interventions and sedation-related complications were substantially reduced in both oxygen groups compared to the control group (P < 0.001).
Conclusions:
- Routine oxygen supplementation is effective in preventing hypoxemia during pediatric moderate and deep sedation.
- Low-flow oxygen via nasal cannula is a viable and effective option, offering a balance of efficacy, cost-effectiveness, and accessibility.
- Both low-flow and high-flow oxygen administration significantly reduce hypoxemia and related complications in sedated children.
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