• Kevin M Overmann, Stephanie D Boyd, Yin Zhang, and Benjamin T Kerrey.
• Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, United States of America. Electronic address: Kevin.Overmann@cchmc.org.
• Am J Emerg Med. 2019 Aug 1; 37 (8): 1416-1421.

BackgroundApneic oxygenation is the delivery of oxygen to the nasopharynx during intubation. It may mitigate the risk of oxyhemoglobin desaturation but has not been well-studied in children.MethodsWe conducted a retrospective, observational study of patients undergoing rapid sequence intubation (RSI) in a pediatric emergency department. We compared patients who received apneic oxygenation, delivered via simple nasal cannula at age-specific flow rates, to patients who did not receive apneic oxygenation. The main outcome was occurrence of oxyhemoglobin desaturation during RSI, defined as oxyhemoglobin saturation dropping to <90% at any time after the administration of paralytic medication and before the endotracheal tube was secured. Data were analyzed using logistic regression, with groups as a fixed effect and patients' age and number of attempts as covariates.ResultsData were collected for 305 of 323 patients who underwent RSI over a 49 month period. Oxyhemoglobin desaturation occurred for 50 patients when apneic oxygenation was used (22%, 95% CI 17% to 28%) and 11 patients without apneic oxygenation (14%, 95% CI 7% to 24%; p > 0.05). There was no difference in the median duration of desaturation or depth of desaturation for the apneic oxygenation group (52 s, 71%) compared to the group without apneic oxygenation (65 s, 79%; p > 0.05). Controlling for covariates, apneic oxygenation was not associated with a lower risk of oxyhemoglobin desaturation, time to desaturation, or depth/duration of desaturation episodes.ConclusionsIn an observational, video-based study of pediatric patients, apneic oxygenation was not associated with a lower risk of oxyhemoglobin desaturation during RSI.Copyright © 2018 Elsevier Inc. All rights reserved.

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