Department of Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, 2200 Children's Way Suite 1025, Nashville, TN 37232, USA.
Department of Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, 2200 Children's Way Suite 1025, Nashville, TN 37232, USA.
Am J Emerg Med. 2019 Jan;37(1):27-32. doi: 10.1016/j.ajem.2018.04.039. Epub 2018 Apr 18.
Apneic oxygenation (AO) has been evaluated in adult patients as a means of reducing hypoxemia during endotracheal intubation (ETI). While less studied in pediatric patients, its practice has been largely adopted.
Determine association between AO and hypoxemia in pediatric patients undergoing ETI.
Observational study at an urban, tertiary children's hospital emergency department. Pediatric patients undergoing ETI were examined during eras without (January 2011-June 2011) and with (August 2014-March 2017) apneic oxygenation. The primary outcome was hypoxemia, defined as pulse oximetry (SpO) < 90%. The χ and Wilcoxon rank-sum tests examined differences between cohorts. Multivariable regression models examined adjusted associations between covariates and hypoxemia.
149 patients were included. Cohorts were similar except for greater incidence of altered mental status in those receiving AO (26% vs. 7%, p = 0.03). Nearly 50% of the pre-AO cohort experienced hypoxemia during ETI, versus <25% in the AO cohort. Median [IQR] lowest SpO during ETI was 93 (69, 99) for pre-AO and 100 [95, 100] for the AO cohort (p < 0.001). In a multivariable logistic regression model, hypoxemia during ETI was associated with AO (aOR 0.3, 95% confidence interval [CI] 0.1-0.8), increased age (for 1 year, aOR 0.8, 95% CI 0.7-1.0), lowest SpO before ETI (for 1% increase, aOR 0.9, 95% CI 0.8-1.0), and each additional intubation attempt (aOR 4.0, 95% CI 2.2-7.2).
Apneic oxygenation is an easily-applied intervention associated with decreases in hypoxemia during pediatric ETI. Nearly 50% of children not receiving AO experienced hypoxemia.
在成人患者中，已经评估了无通气氧合（AO）作为减少气管插管（ETI）期间低氧血症的一种手段。虽然在儿科患者中研究较少，但它的应用已被广泛采用。
确定儿科患者在接受 ETI 期间接受 AO 与低氧血症之间的关联。
这是一项在城市三级儿童医院急诊科进行的观察性研究。在没有（2011 年 1 月至 2011 年 6 月）和有（2014 年 8 月至 2017 年 3 月）无通气氧合的时期，对接受 ETI 的儿科患者进行检查。主要结局是低氧血症，定义为脉搏血氧饱和度（SpO）<90%。χ检验和 Wilcoxon 秩和检验检查了队列之间的差异。多变量回归模型检查了协变量与低氧血症之间的调整关联。
共纳入 149 名患者。除了接受 AO 的患者中改变精神状态的发生率更高（26% vs. 7%，p=0.03）外，两组之间没有差异。在接受 AO 治疗的患者中，近 50%的患者在 ETI 期间发生低氧血症，而在未接受 AO 治疗的患者中，这一比例低于 25%。接受 AO 治疗患者的 ETI 期间最低 SpO 中位数[IQR]为 93（69，99），未接受 AO 治疗患者的 SpO 中位数[IQR]为 100[95，100]（p<0.001）。在多变量逻辑回归模型中，ETI 期间的低氧血症与 AO（比值比 0.3，95%置信区间 [CI] 0.1-0.8）、年龄增加（每增加 1 岁，比值比 0.8，95%CI 0.7-1.0）、ETI 前最低 SpO（每增加 1%，比值比 0.9，95%CI 0.8-1.0）和每次额外的插管尝试（比值比 4.0，95%CI 2.2-7.2）有关。
无通气氧合是一种易于应用的干预措施，可降低儿科 ETI 期间的低氧血症发生率。近 50%的未接受 AO 治疗的儿童出现低氧血症。
