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Apneic time during intubation in critically ill children.

Theerapon Jariyasakoolroj1,2, Taiki Kojima3, Shefali Godara4

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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.

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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.