Factors Associated with Desaturation in Pediatric Intubations
<i><strong>Katherine Bakes, MD</strong></i>
<i>Longer duration of intubation attempt, but not number of attempts, was associated with desaturation, particularly in children younger than 24 months.</i>
In a prior study of pediatric rapid sequence intubation, oxyhemoglobin desaturation (SpO2 <90%) occurred in 33% of 144 children (half younger than 24 months) who underwent 221 intubations at a high-volume, academic pediatric emergency department during a 1-year period (<a href=”http://www.jwatch.org/em201210120000003″ target=”_blank”>NEJM JW Emerg Med Nov 2012</a> and Ann Emerg Med 2012; 60:251). Now, in a planned secondary analysis, investigators reviewed videos to identify variables associated with desaturation.
One third of patients had ≥1 episode of desaturation. Desaturation was more common in patients younger versus older than 24 months (59% vs. 10%). The median duration of attempts was 35 seconds; 13 attempts (6%) lasted longer than 90 seconds. The probability of successful endotracheal tube placement decreased with longer attempt duration; success rates for 30-, 45-, 60-, and 75-second attempts were 46%, 42%, 36%, and 25%, respectively. The odds of desaturation for individual attempts lasting longer than 30 and 90 seconds were 2 and 8, respectively, compared with a reference of 1 second. Although desaturation was associated with the duration of both total cumulative and individual attempts, it was not associated with number of attempts.
Because saturations will drop precipitously in children, particularly the very young, providers should immediately commence bagging at the first sign of any decrease in oxygen saturations.
Rinderknecht AS et al. Factors associated with oxyhemoglobin desaturation during rapid sequence intubation in a pediatric emergency department: Findings from multivariable analyses of video review data. <em>Acad Emerg Med</em> 2015 Mar 15; [e-pub].
(<a href=”http://dx.doi.org/10.1111/acem.12633″ target=”_blank”>http://dx.doi.org/10.1111/acem.12633</a>)
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