Apneic Oxygenation during Rapid Sequence Intubation in Critically Ill Children

Todd Mortimer; Jeff Burzynski; Murray Kesselman; Jeff Vallance; Gregory Hansen

doi:10.1055/s-0035-1568149

Journal of Pediatric Intensive Care, Inhaltsverzeichnis

J Pediatr Intensive Care 2016; 05(01): 028-031
DOI: 10.1055/s-0035-1568149

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Apneic Oxygenation during Rapid Sequence Intubation in Critically Ill Children

Todd Mortimer

¹Section of Pediatric Intensive Care, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada

,

Jeff Burzynski

¹Section of Pediatric Intensive Care, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada

,

Murray Kesselman

¹Section of Pediatric Intensive Care, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada

,

Jeff Vallance

²Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada

,

Gregory Hansen

¹Section of Pediatric Intensive Care, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada

› Institutsangaben

Abstract

This prospective case series documented hypoxemia and potential complications associated with apneic oxygenation in critically ill pediatric patients during rapid sequence intubation. Forty-four patients received apneic oxygenation via nasal cannula at rates of 5, 10, and 15 L/min for ages <4, 4 to 12, and 12 to 18 years, respectively. Pre- and postintubation attempt mean Spo ₂ were 98.9 ± 2.95 and 90.7 ± 1.95%, respectively. Postintubation Spo ₂ < 80% were significantly less with one intubation attempt, compared with multiple attempts (p < 0.001). No serious complications were noted. Apneic oxygenation was well tolerated in critically ill children.

Keywords

apneic oxygenation - hypoxemia - airway management

Volltext

Referenzen

References
1 Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med 2012; 59 (3) 165-75.e1
2 Weingart SD. Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department. J Emerg Med 2011; 40 (6) 661-667
3 Graciano AL, Tamburro R, Thompson AE, Fiadjoe J, Nadkarni VM, Nishisaki A. Incidence and associated factors of difficult tracheal intubations in pediatric ICUs: a report from National Emergency Airway Registry for Children: NEAR4KIDS. Intensive Care Med 2014; 40 (11) 1659-1669
4 Davis DP, Hwang JQ, Dunford JV. Rate of decline in oxygen saturation at various pulse oximetry values with prehospital rapid sequence intubation. Prehosp Emerg Care 2008; 12 (1) 46-51
5 Mort TC. The incidence and risk factors for cardiac arrest during emergency tracheal intubation: a justification for incorporating the ASA Guidelines in the remote location. J Clin Anesth 2004; 16 (7) 508-516
6 Nishisaki A, Turner DA, Brown III CA, Walls RM, Nadkarni VM ; National Emergency Airway Registry for Children (NEAR4KIDS); Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. A National Emergency Airway Registry for children: landscape of tracheal intubation in 15 PICUs. Crit Care Med 2013; 41 (3) 874-885
7 Moran C, Karalapillai D, Darvall J, Nanuan A. Is it time for apnoeic oxygenation during endotracheal intubation in critically ill patients?. Crit Care Resusc 2014; 16 (3) 233-235
8 Engström J, Hedenstierna G, Larsson A. Pharyngeal oxygen administration increases the time to serious desaturation at intubation in acute lung injury: an experimental study. Crit Care 2010; 14 (3) R93 10.1186/cc9027
9 Wimalasena Y, Burns B, Reid C, Ware S, Habig K. Apneic oxygenation was associated with decreased desaturation rates during rapid sequence intubation by an Australian helicopter emergency medicine service. Ann Emerg Med 2015; 65 (4) 371-376
10 Nakagawa TA, Ashwal S, Mathur M, Mysore M ; Committee For Determination Of Brain Death In Infants Children. Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations-executive summary. Ann Neurol 2012; 71 (4) 573-585
11 Gausche-Hill M. High flow nasal cannula during RSI: does it prevent desaturation? Advanced Pediatric Emergency Medicine Assembly. Available at: http://www.acep.org/uploadedFiles/ACEP/MeetingSites/PEM/Educational_Programs/Gausche-Hill%20-%20High%20Flow%20Nasal%20Cannula%202013%20rev.pdf . Accessed July 20, 2015