Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children

Critical Care

Research

David Tellez¹  Nina Salfity¹  Justine Shults²  Akira Nishisaki²  Vinay Nadkarni²  Christopher Page-Goertz³  Simon J. Parsons⁴  Lauren Edwards⁵  Aileen Kirby⁶  Keiko M. Tarquinio⁷  Conrad Krawiec⁸  Lee Polikoff⁹  Sholeen Nett^1,10  Ryan Breuer^1,11  Gordon Krahn^1,12  Natalie Napolitano^1,13 

[1] Department of Critical Care, Phoenix Children’s Hospital, Phoenix, AZ, USA;Division of Anesthesia and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA;Division of Critical Care Medicine, Akron Children’s Hospital, Akron, OH, USA;Division of Critical Care, Alberta Children’s Hospital, Calgary, Canada;Division of Critical Care, Department of Pediatrics, Children’s Healthcare of Atlanta, University of Nebraska Medical Center and Children’s Hospital and Medical Center, Omaha, NE, USA;Division of Pediatric Critical Care Medicine, Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, OR, USA;Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA;Division of Pediatric Critical Care Medicine, Penn State Health Children’s Hospital, Hershey, PA, USA;Division of Pediatric Critical Care Medicine, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA;Division of Pediatric Critical Care, Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA;Division of Pediatric Critical Care, Oishei Children’s Hospital, Buffalo, NY, USA;Division of Pediatric Critical Care, University of British Columbia, Vancouver, BC, Canada;Respiratory Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA, USA;

关键词: Pediatrics;    Tracheal intubation;    Airway;    Hypoxemia;    Apneic oxygenation;   

DOI  :  10.1186/s13054-023-04304-0

 received in 2022-09-24, accepted in 2023-01-06,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDetermine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI), reduces adverse TI-associated events (TIAEs) in children.MethodsAO was implemented across 14 pediatric intensive care units as a quality improvement intervention during 2016–2020. Implementation consisted of an intubation safety checklist, leadership endorsement, local champion, and data feedback to frontline clinicians. Standardized oxygen flow via nasal cannula for AO was as follows: 5 L/min for infants (< 1 year), 10 L/min for young children (1–7 years), and 15 L/min for older children (≥ 8 years). Outcomes were the occurrence of adverse TIAEs (primary) and hypoxemia (SpO2 < 80%, secondary).ResultsOf 6549 TIs during the study period, 2554 (39.0%) occurred during the pre-implementation phase and 3995 (61.0%) during post-implementation phase. AO utilization increased from 23 to 68%, p < 0.001. AO was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patient intubated due to respiratory or neurological failure or shock. Conversely, AO was used more often in TIs done for procedures and those assisted by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%, p < 0.001), aOR 0.75 (95% CI 0.58–0.98, p = 0.03) after adjusting for site clustering (primary analysis). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs: aOR 0.90, 95% CI 0.72–1.12, p = 0.33 and the occurrence of hypoxemia was not different: AO 14.2% versus without AO 15.2%, p = 0.43.ConclusionWhile AO use was associated with a lower occurrence of adverse TIAEs in children who required TI in the pediatric ICU after accounting for site-level clustering, this result may be explained by differences in patient, provider, and practice factors.Trial Registration Trial not registered.

【 授权许可】

CC BY   
© The Author(s) 2023

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