• Eun-Hee Kim, Jung-Bin Park, Pyoyoon Kang, Sang-Hwan Ji, Young-Eun Jang, Ji-Hyun Lee, Hee-Soo Kim, and Jin-Tae Kim.
• From the Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea (E-HK, J-BP, PK, S-HJ, Y-EJ, J-HL, H-SK, J-TK).
• Eur J Anaesthesiol. 2024 Sep 1; 41 (9): 687694687-694.

BackgroundHypoxaemia occurs frequently during paediatric laryngeal microsurgery.ObjectiveThe oxygen reserve index is a noninvasive and continuous parameter to assess PaO2 levels in the range of 100 to 200 mmHg. It ranges from 0 to 1.0. We investigated whether monitoring the oxygen reserve index can reduce the incidence of SpO2 90% or less.DesignRandomised controlled trial.SettingA tertiary care paediatric hospital.ParticipantsPaediatric patients aged 18 years or less scheduled to undergo laryngeal microsurgery.InterventionThe patients were randomly allocated to the oxygen reserve index or control groups, and stratified based on the presence of a tracheostomy tube. Rescue intervention was performed when the oxygen reserve index was 0.2 or less and the SpO2 was 94% or less in the oxygen reserve index and control groups, respectively.Main Outcome MeasureThe primary outcome was the incidence of SpO2 90% or less during the surgery.ResultsData from 88 patients were analysed. The incidence of SpO2 ≤ 90% did not differ between the oxygen reserve index and control groups [P = 0.114; 11/44, 25% vs. 18/44, 40.9%; relative risk: 1.27; and 95% confidence interval (CI): 0.94 to 1.72]. Among the 128 rescue interventions, SpO2 ≤ 90% event developed in 18 out of 75 events (24%) and 42 out of 53 events (79.2%) in the oxygen reserve index and control groups, respectively (P < 0.001; difference: 55.2%; and 95% CI 38.5 to 67.2%). The number of SpO2 ≤ 90% events per patient in the oxygen reserve index group (median 0, maximum 3) was less than that in the control group (median 0, maximum 8, P = 0.031).ConclusionAdditional monitoring of the oxygen reserve index, with a target value of greater than 0.2 during paediatric airway surgery, alongside peripheral oxygen saturation, did not reduce the incidence of SpO2 ≤ 90%.Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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