Apnoeic oxygenation during paediatric intubation: A systematic review

Shane George; Megan Wilson; Susan Humphreys; Kristen Gibbons; Elliot Long; Andreas Schibler

doi:10.3389/fped.2022.918148

Apnoeic oxygenation during paediatric intubation: A systematic review

Front Pediatr. 2022 Nov 21:10:918148. doi: 10.3389/fped.2022.918148. eCollection 2022.

Authors

Shane George^{1

2

3}, Megan Wilson^{4

5}, Susan Humphreys^{3

6}, Kristen Gibbons³, Elliot Long^{7

8

9}, Andreas Schibler^{10

11}

Affiliations

¹ Departments of Emergency Medicine and Children's Critical Care, Gold Coast University Hospital, Southport, QLD, Australia.
² School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.
³ Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.
⁴ Emergency Department, Tweed Heads Hospital, Tweed Heads, NSW, Australia.
⁵ Emergency Department, Lismore Base Hospital, Lismore, NSW, Australia.
⁶ Department of Anaesthesia, Queensland Children's Hospital, Brisbane, QLD, Australia.
⁷ Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia.
⁸ Clinical Sciences, Murdoch Children's Research Institute, VIC, Australia.
⁹ Department of Critical Care, University of Melbourne, VIC, Australia.
¹⁰ Critical Care Research Group, Intensive Care Unit, St Andrews War Memorial Hospital, Brisbane, QLD, Australia.
¹¹ Wesley Medical Research, Auchenflower, QLD, Australia.

Abstract

Objective: This review assesses the effect of apnoeic oxygenation during paediatric intubation on rates of hypoxaemia, successful intubation on the first attempt and other adverse events.

Data sources: The databases searched included PubMed, Medline, CINAHL, EMBASE and The Cochrane Library. An electronic search for unpublished studies was also performed.

Study selection: We screened studies that include children undergoing intubation, studies that evaluate the use of apnoeic oxygenation by any method or device with outcomes of hypoxaemia, intubation outcome and adverse events were eligible for inclusion.

Data extraction: Screening, risk of bias, quality of evidence and data extraction was performed by two independent reviewers, with conflicts resolved by a third reviewer where consensus could not be reached.

Data synthesis: From 362 screened studies, fourteen studies (N = 2442) met the eligibility criteria. Randomised controlled trials (N = 482) and studies performed in the operating theatre (N = 835) favoured the use of apnoeic oxygenation with a reduced incidence of hypoxaemia (RR: 0.34, 95% CI: 0.24 to 0.47, p < 0.001, I ² = 0% and RR: 0.27, 95% CI: 0.11 to 0.68, p = 0.005, I ² = 68% respectively). Studies in the ED and PICU were of lower methodological quality, displaying heterogeneity in their results and were unsuitable for meta-analysis. Among the studies reporting first attempt intubation success, there were inconsistent effects reported and data were not suitable for meta-analysis.

Conclusion: There is a growing body of evidence to support the use of apnoeic oxygenation during the intubation of children. Further research is required to determine optimal flow rates and delivery technique. The use of humidified high-flow oxygen shows promise as an effective technique based on data in the operating theatre, however its efficacy has not been shown to be superior to low flow oxygen in either the elective anesthetic or emergency intubation situations Systematic Review Registration: This review was prospectively registered in the PROSPERO international register of systematic reviews (Reference: CRD42020170884, registered April 28, 2020).

Keywords: apnoeic oxygenation; hypoxaemia; intubation; paediatric; safe apnoeic period.

Publication types

Review