Abstract
<h3>Introduction</h3> Prior data suggest that a higher preoxygenation target may be justified during pediatric rapid sequence intubation (RSI) to avoid oxygen desaturation. This may involve increased use of positive-pressure ventilation (PPV) in patients with initial SpO2 ≥94%. The safety of this approach is unknown. <h3>Methods</h3> All air medical pediatric RSI patients treated by a large air medical company over a 5-year period were included. Patients were stratified by initial SpO2 value [97-100%, 94-96%, <94%] and compared with regard to PPV use during preoxygenation and a reported complication of aspiration <h3>Results</h3> A total of 1,067 pediatric RSI patients were included. PPV rates increased with decreasing initial SpO2 [97-100%: 389/765 (51%), 94-96%: 78/130 (60%), <94%: 151/172 (88%)]. Increased aspiration rates with PPV were reported only in patients with initial SpO2 <94% vs ≥94% (3.3% vs 0.3%, p=0.011). <h3>Conclusion</h3> A low risk of aspiration with PPV was observed in air medical pediatric RSI patients with SpO2 values ≥94%. This may justify more aggressive use of PPV to achieve higher preoxygenation targets to avoid oxygen desaturation.
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