Apneic time during intubation in critically ill children shows no clear link to desaturation

In this observational study the median apneic time was 54 seconds and long apneic time (>54 s) was not significantly associated with oxygen desaturation; use of apneic oxygenation was associated with lower odds of desaturation (adjusted OR 0.17, 95% CI 0.07–0.43).

This observational study examined apneic time during tracheal intubation of critically ill children and outcomes related to oxygen desaturation. The analysis compared long apneic time (>54 seconds) with short apneic time (≤54 seconds), and assessed the association of apneic oxygenation with desaturation. The study period included evolving airway practices such as wider videolaryngoscope availability and airway safety bundles, and the sample included a higher frequency of infants with longer apneic times. Key findings: - Oxygen desaturation below 90% occurred in 28 intubations and did not differ significantly between long and short apneic times (16.7% vs. 10.8%, p = 0.226). - The median magnitude of desaturation was 0% (IQR 0–0) in both apneic time groups with no significant difference (p = 0.075). - After adjusting for age and apneic oxygenation use, long apneic time was not significantly associated with odds of desaturation (adjusted OR 1.92, 95% CI 0.81–4.59, p = 0.141). - Use of apneic oxygenation (delivered via nasal cannula at recommended flow rates) was associated with lower odds of oxygen desaturation (adjusted OR 0.17, 95% CI 0.07–0.43, p < 0.001). - The median apneic time in the cohort was 54 seconds, and infants more often experienced longer apneic times. Summary: The study found no significant association between longer apneic time and oxygen desaturation, while apneic oxygenation use was associated with reduced odds of desaturation. Limitations included a small, daytime convenience sample, differences in data collection between settings, and incomplete capture of potential confounders such as comorbidities. The authors note that patient physiology and procedural factors likely influence desaturation risk, and they recommend larger, multicenter investigations to clarify these relationships; Undetermined at this time.