578 - Procedural sedation supplemental pre-oxygenation association with major airway events and interventions

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 578
Publication Number: 578.364

Presenting Author(s)

JL

Joyce Li, MD MPH

Assistant Professor of Pediatrics and Emergency Medicine
Boston Children's Hospital
boston, Massachusetts, United States

Background: While major adverse events in pediatric sedations are rare, they are potentially life threatening. Supplemental pre-oxygenation (oxygenation started without indication during pre-induction and/or induction) is an easy to use, low-cost strategy with the potential to decrease major adverse airway events.

Objective: Our objectives were to describe practice patterns of supplemental pre-oxygenation, and to test the association between the use of supplemental pre-oxygenation, major airway events, and need for major interventions among sedated patients.

Design/Methods: We performed a retrospective, multicenter, cross-sectional study of pediatric sedations from April 27, 2020 - November 30, 2021 using the Pediatric Sedation Research Consortium multicenter database. The patient- and sedation-level demographic and clinical characteristics, stratified by pre-oxygenation status, were described using frequencies and proportions. We performed two multivariable logistic regression models for major airway events and major interventions (Table 2), respectively, as the dependent variables and supplemental oxygenation, patient level and sedation level characteristics as the independent variables. We also determined the site-level prevalence of pre-oxygenation utilization.

Results:

There were a total of 35,915 pediatric sedations in the study cohort. 22,802 (63%) utilized supplemental pre-oxygenation. The most frequent groups to receive preoxygenation were children age 1-4 years old (n=9,120; 40.0%) ASA class II (n=13,623; 59.7%), radiologic procedure (n=9,753; 42.8%), and hematologic/oncologic indication (n=7,075; 31.0%) (Table 1). The utilization of pre-oxygenation across institutions ranged from 0 to 100% with 25/36 (69%) institutions using pre-oxygenation in a majority of their patients (Figure 1). Among sedations utilizing pre-oxygenation, there was a 62% decreased odds of a major airway event (OR=0.38; 95% CI 0.24-0.60) but no statistical difference in the requirement for a major intervention (OR=0.68; 95% CI 0.36-1.27) (Table 2).

Conclusion(s):

The use of supplemental pre-oxygenation was associated with decreased odds of major airway events. While we did not find a concurrent decrease in major interventions, supplemental pre-oxygenation is nonetheless a low cost, widely available tool for clinicians to use. Further study into more specific high-risk populations is needed to elucidate best practice for utilization of supplemental pre-oxygenation.