Apneic nasal oxygenation and safe apnea time during pediatric intubations by learners

Background Apneic nasal oxygenation (ApOx) prolongs the time to desaturation during intubation of adult patients, but there is limited prospective evidence for apneic oxygenation in pediatric patients. Aims We hypothesized that ApOx during operating room intubation of pediatric patients by inexperienced learners would prolong the interval before desaturation. Methods This prospective observational study compared intubation data for 196 pediatric surgical patients intubated by learners under baseline practice (no nasal cannula), to 160 patients enrolled after adoption of routine apneic nasal cannula oxygenation at 5 L/min. The primary outcome was elapsed time between anesthetic induction and pulse oximetry (SpO(2)) falling to 95, if ever. Results Nasal cannula oxygenation during intubation by learners delayed desaturation to SpO(2) 95 (risk ratio for this event before intubation 0.05, 95% CI 0.03-0.09; P < 0.0001). Conclusions Apneic oxygenation via nasal cannula during intubation of pediatric surgical patients prolongs time before desaturation, thus extending the safe interval for airway management by learners.