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Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Apneic time during intubation in critically ill children
Theerapon Jariyasakoolroj1,2, Taiki Kojima3, Shefali Godara4
1Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, Philadelphia, PA, USA. nui_th2@hotmail.com.
Insights
Prolonged apneic time during pediatric tracheal intubation is not linked to oxygen desaturation. However, using apneic oxygenation significantly lowers desaturation risk in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Airway Management
- Respiratory Physiology
Background:
- Prolonged apneic periods during tracheal intubation in children can lead to oxygen desaturation.
- Identifying factors associated with extended apneic times is crucial for patient safety.
Purpose of the Study:
- To determine factors linked to prolonged apneic times during pediatric tracheal intubation.
- To investigate the association between apneic duration and oxygen desaturation in children.
Main Methods:
- Prospective observational study of 204 children under 18 undergoing oral tracheal intubation.
- Apneic time measured, with a 54-second cutoff for 'long' apneic time.
- Oxygen desaturation defined as SpO2 <90% in children with baseline SpO2 >90%.
Main Results:
- Median apneic time was 54 seconds; longer apneic times were more frequent in infants.
- Apneic time did not vary by difficult airway history, provider, or laryngoscope type.
- Oxygen desaturation rates were similar between short and long apneic groups; apneic oxygenation reduced desaturation risk.
Conclusions:
- Patient age was associated with longer apneic times during tracheal intubation.
- Apneic time duration was not independently linked to oxygen desaturation.
- Apneic oxygenation use was significantly associated with a lower incidence of oxygen desaturation, supporting its routine use.
Background:
Prolonged apneic time during tracheal intubation (TI) may increase the risk of oxygen desaturation in critically ill children. This study aimed to identify factors associated with long apneic times and examine the relationship between apneic duration and oxygen desaturation.
Methods:
We conducted a prospective observational study of children <18 years undergoing oral TI in the pediatric intensive care unit and emergency department of a large academic children's hospital. Apneic time was measured and categorized as short or long using a 54-s cutoff. Desaturation was defined as SpO₂ <90% during the apneic period in children with baseline SpO₂ >90%.
Results:
Among 204 TIs, the median apneic time was 54 s. Long apneic times were more common in infants than in younger children or older children. Apneic time did not differ by history of a difficult airway, provider type, laryngoscope type, or apneic oxygenation use. Oxygen desaturation rates were similar between long and short groups. There was no significant association between long apneic time and desaturation while apneic oxygenation significantly reduced desaturation risk.
Conclusions:
Patient age was associated with long apneic times. While apneic time was not associated with desaturation, apneic oxygenation use was associated with lower occurrence of oxygen desaturation.
Impact:
This study found that longer apneic times during pediatric tracheal intubation were not independently associated with oxygen desaturation after adjusting for patient age and apneic oxygenation use. Apneic oxygenation significantly reduced the risk of desaturation, supporting its routine use during tracheal intubation in critically ill children. These findings add evidence supporting age-specific airway strategies and highlight the importance of modifiable practices to improve the safety of pediatric airway management.
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