Apneic oxygenation reduces hypoxemia during endotracheal intubation in the pediatric emergency department

Background: 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. Objective: Determine association between AO and hypoxemia in pediatric patients undergoing ETI. Methods: 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 (SpO₂) < 90%. The χ² and Wilcoxon rank-sum tests examined differences between cohorts. Multivariable regression models examined adjusted associations between covariates and hypoxemia. Results: 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 SpO₂ 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 SpO₂ 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). Conclusions: Apneic oxygenation is an easily-applied intervention associated with decreases in hypoxemia during pediatric ETI. Nearly 50% of children not receiving AO experienced hypoxemia.