Oxygenation In Children Research Articles

Clinical characteristics and long-term outcomes of Venoarterial extracorporeal membrane oxygenation in children with congenital heart disease.

To analyze the clinical outcomes of extracorporeal membrane oxygenation (ECMO) support in children with congenital heart disease (CHD) after surgery and explore the risk factors associated with mortality during long-term follow-up for 3-5 years. We conducted a retrospective observational study at Shanghai Children Medical Center (SCMC) from 2017 to 2021 and reviewed the clinical results and laboratory findings of 188 CHD patients who received ECMO support during this period. The 5-year overall survival rate was 56.38% (106/188) among CHD patients who received ECMO support. Kaplan-Meier curve showed residual anatomical malformation (RAM) (p < 0.0001), gastrointestinal bleeding (p = 0.019), single ventricular (SV) (p = 0.028), and pre-ECMO lactate level >10 mmol/L (p < 0.0001) were significantly associated with higher mortality in follow-up. Cox analysis identified RAM (p = 0.039) and pre-ECMO lactate level >10 mmol/L (p < 0.001) as independent risk factors for overall survival. Conversely, a minimum platelet count ≥50 × 109/L (p < 0.001) was found to be a protective factor. Moreover, a competing risk model showed that a CPR time ≥60 min (p < 0.001) was identified as a risk factor for death in patients who failed to be discharged from the hospital. Our study showed characteristics of long-term follow-up patients and revealed several risk factors associated with mortality in children with CHD who received ECMO support. These findings can provide valuable insights for clinical decision-making and contribute to improving patient outcomes.

Initial experience with pump controlled retrograde trial-off (PCRTO) veno-arterial extra corporeal membrane oxygenation in children.

Pump Controlled Retrograde Trial Off (PCRTO) is a relatively new technique in trialing-off Veno-Arterial Extra Corporeal Membrane Oxygenation (VA-ECMO). Literature on the use of PCRTO in children remains scarce. We describe our centre's initial experience with PCRTO in a neonate and an older child and review its potential advantages and disadvantages compared to traditional weaning methods. More research and shared best practices are required in children to facilitate wider adoption of this technique.

Is there a role for extracorporeal membrane oxygenation in children with acute liver failure? A retrospective analysis of the Extracorporeal Life Support Organization Registry.

Our results suggest that the use of ECMO for the management of respiratory and cardiac failure in patients with PALF should be considered with caution and that further research is needed to understand its role in this specific high-risk population. • Pediatric acute liver failure (PALF) is a clinical syndrome associated with significant morbidity and mortality. • Data on the use of extracorporeal membrane oxygenation (ECMO) in the context of PALF are scarce and controversial. • ECMO to manage acute respiratory and/or cardiac failure in the context of PALF should be considered with caution. • Bleeding and thrombotic complications in children with acute liver failure receiving ECMO are similar to the ones reported in the general pediatric population.

The Impact of Increased PEEP on Hemodynamics, Respiratory Mechanics, and Oxygenation in Pediatric ARDS.

PEEP is a cornerstone treatment for children with pediatric ARDS. Unfortunately, its titration is often performed solely by evaluating oxygen saturation, which can lead to inadequate PEEP level settings and consequent adverse effects. This study aimed to assess the impact of increasing PEEP on hemodynamics, respiratory system mechanics, and oxygenation in children with ARDS. Children receiving mechanical ventilation and on pressure-controlled volume-guaranteed mode were prospectively assessed for inclusion. PEEP was sequentially changed to 5, 12, 10, 8 cm H2O, and again to 5 cm H2O. After 10 min at each PEEP level, hemodynamic, ventilatory, and oxygenation variables were collected. A total of 31 subjects were included, with median age and weight of 6 months and 6.3 kg, respectively. The main reasons for pediatric ICU admission were respiratory failure caused by acute viral bronchiolitis (45%) and community-acquired pneumonia (32%). Most subjects had mild or moderate ARDS (45% and 42%, respectively), with a median (interquartile range) oxygenation index of 8.4 (5.8-12.7). Oxygen saturation improved significantly when PEEP was increased. However, although no significant changes in blood pressure were observed, the median cardiac index at PEEP of 12 cm H2O was significantly lower than that observed at any other PEEP level (P = .001). Fourteen participants (45%) experienced a reduction in cardiac index of > 10% when PEEP was increased to 12 cm H2O. Also, the estimated oxygen delivery was significantly lower, at 12 cm H2O PEEP. Finally, respiratory system compliance significantly reduced when PEEP was increased. At a PEEP of 12 cm H2O, static compliance had a median reduction of 25% in relation to the initial assessment (PEEP of 5 cm H2O). Although it may improve arterial oxygen saturation, inappropriately high PEEP levels may reduce cardiac output, oxygen delivery, and respiratory system compliance in pediatric subjects with ARDS with low potential for lung recruitability.

High-flow nasal oxygen for children's airway surgery to reduce hypoxaemic events: a randomised controlled trial

Tubeless upper airway surgery in children is a complex procedure in which surgeons and anaesthetists share the same operating field. These procedures are often interrupted for rescue oxygen therapy. The efficacy of nasal high-flow oxygen to decrease the frequency of rescue interruptions in children undergoing upper airway surgery is unknown. In this multicentre randomised trial conducted in five tertiary hospitals in Australia, children aged 0-16 years who required tubeless upper airway surgery were randomised (1:1) by a web-based randomisation tool to either nasal high-flow oxygen delivery or standard oxygen therapy (oxygen flows of up to 6 L/min). Randomisation was stratified by site and age (<1 year, 1-4 years, and 5-16 years). Subsequent tubeless upper airway surgery procedures in the same child could be included if there were more than 2 weeks between the procedures, and repeat surgical procedures meeting this condition were considered to be independent events. The oxygen therapy could not be masked, but the investigators remained blinded until outcome data were locked. The primary outcome was successful anaesthesia without interruption of the surgical procedure for rescue oxygenation. A rescue oxygenation event was defined as an interruption of the surgical procedure to deliver positive pressure ventilation using either bag mask technique, insertion of an endotracheal tube, or laryngeal mask to improve oxygenation. There were ten secondary outcomes, including the proportion of procedures with a hypoxaemic event (SpO2 <90%). Analyses were done on an intention-to-treat (ITT) basis. Safety was assessed in all enrolled participants. This trial is registered in the Australian New Zealand Clinical Trials Registry, ACTRN12618000949280, and is completed. From Sept 4, 2018, to April 12, 2021, 581 procedures in 487 children were randomly assigned to high-flow oxygen (297 procedures) or standard care (284 procedures); after exclusions, 528 procedures (267 assigned to high-flow oxygen and 261 assigned to standard care) in 483 children (293 male and 190 female) were included in the ITT analysis. The primary outcome of successful anaesthesia without interruption for tubeless airway surgery was achieved in 236 (88%) of 267 procedures on high-flow oxygen and in 229 (88%) of 261 procedures on standard care (adjusted risk ratio [RR] 1·02, 95% CI 0·96-1·08, p=0·82). There were 51 (19%) procedures with a hypoxaemic event in the high-flow oxygen group and 57 (22%) in the standard care group (RR 0·86, 95% CI 0·58-1·24). Of the other prespecified secondary outcomes, none showed a significant difference between groups. Adverse events of epistaxis, laryngospasm, bronchospasm, hypoxaemia, bradycardia, cardiac arrest, hypotension, or death were similar in both study groups. Nasal high-flow oxygen during tubeless upper airway surgery did not reduce the proportion of interruptions of the procedures for rescue oxygenation compared with standard care. There were no differences in adverse events between the intervention groups. These results suggest that both approaches, nasal high-flow or standard oxygen, are suitable alternatives to maintain oxygenation in children undergoing upper airway surgery. Thrasher Research Fund, the Australian and New Zealand College of Anaesthetists, the Society for Paediatric Anaesthesia in New Zealand and Australia.

Comparison of SpO2- with PaO2-Based Indices of Oxygenation in Children with Respiratory Failure

AbstractGiven the widespread availability of pulse oximetry and its potential to replace partial pressure of arterial oxygen (PaO2)-based indices of oxygenation, we aimed to study the correlation between pulse oximetry-based oxygen saturation (SpO2)- and PaO2-based indices of oxygenation namely, SpO2/FiO2 (SF) ratio with PaO2/FiO2 (PF) ratio and oxygen saturation index (OSI) with oxygenation index (OI) under varying physiological conditions, along with accuracy measures for SpO2-based indices. Inclusion criteria included children (1 month to 18 years) admitted to pediatric intensive care unit needing invasive ventilation for hypoxemic respiratory failure with SpO2 ≥ 80% and having an indwelling arterial catheter. A total of 1,237 sets of simultaneous PaO2, SpO2 readings, and ventilator parameters were recorded. There was a moderate correlation between SF and PF ratios (r s = 0.68, p &lt; 0.001) and strong correlation between OSI and OI (r s = 0.89, p &lt; 0.001). We obtained SF ratios of 271, 235, and 200 corresponding to PF ratios of 300, 200, and 100, respectively. SF ratio showed a good discrimination ability to identify moderate (area under the receiver operating characteristic curve [AUROC] = 0.901) and severe acute respiratory distress syndrome (ARDS; AUROC = 0.889) and fair discrimination ability for mild ARDS (AUROC = 0.770). OSI of 4.1, 6.4, and 11.1 corresponded to OI of 4, 8, and 16, respectively. OSI demonstrated an excellent discrimination ability for diagnosing mild (AUROC = 0.928), moderate (AUROC = 0.961), and severe ARDS (AUROC = 0.965). The correlation between SF/PF ratio and OSI/OI was the strongest in the lowest SpO2 range studied. SpO2-based indices of oxygenation could replace PaO2-based indices with reasonable accuracy for patients with SpO2 values ≥ 80%.

Is Prone Positioning Worth the Turn in Pediatrics? Unraveling the Oxygenation Mystery in Ventilated Patients with Acute Respiratory Distress Syndrome: An Observational Study Introducing a Novel SF Ratio Method for Non-Invasive Monitoring in Children

Background: Respiratory illnesses are prevalent among children, attributed to factors such as immature immune systems, anatomical variations, and increased susceptibility to infections. Acute respiratory distress syndrome (ARDS) is a significant cause of morbidity and mortality, necessitating various forms of respiratory support in pediatric intensive care units (PICUs). Prone positioning has emerged as a strategy to improve oxygenation in ARDS, but its effectiveness and correlation with non-invasive monitoring parameters remain underexplored.&#x0D; Subjects and Methods: This prospective observational study, conducted in the PICU of Dr. B.C Roy PGIPS, Kolkata, aimed to assess the impact of prone ventilation on oxygenation in children diagnosed with ARDS. The study, spanning 18 months, included 40 patients aged 3 months to 12 years requiring mechanical ventilation. Parameters such as oxygenation index (OI), oxygen saturation index (OSI), PF ratio, and SF ratio were monitored at different time points during supine and prone ventilation. Prone positioning's effectiveness was evaluated based on improvements in these parameters.&#x0D; Results: The study revealed a significant improvement in oxygenation status after four hours of prone ventilation compared to supine ventilation. Oxygenation index, OSI, SF ratio, and PF ratio showed statistically significant changes favoring prone positioning. A strong positive correlation between SF ratio and PF ratio was observed at various time points, emphasizing the potential of SF ratio as a non-invasive alternative. Responders and non-responders to prone positioning were identified based on predefined criteria, highlighting individual variability in treatment response.&#x0D; Conclusion: Prone ventilation demonstrated significant improvements in oxygenation parameters in children with ARDS. The study supports the use of non-invasive SF ratio as a reliable substitute for PF ratio, simplifying monitoring without invasive arterial sampling. This finding has implications for improving ARDS management strategies in pediatric patients, offering a less cumbersome alternative for assessing oxygenation status.

Cerebral oxygenation saturation in childhood: difference by age and comparison of two cerebral oximetry algorithms.

Few reports are available on the monitoring of regional cerebral oxygen saturation (rSO2) in pediatric patients undergoing non-cardiac surgical procedures. In addition, no study has examined the rSO2 levels in children of a broad age range. In this study, we aimed to assess and compare rSO2 levels in pediatric patients of different age groups undergoing non-cardiac surgery. We used two oximeters, tNIRS-1, which uses time-resolved spectroscopy, and conventional INVOS 5100C. Seventy-eight children-26 infants, 26 toddlers, and 26 schoolchildren-undergoing non-cardiac surgery were included. We investigated the differences in the rSO2 levels among the age groups and the correlation between the models and physiological factors influencing the rSO2 values. rSO2 measured by INVOS 5100C was significantly lower in infants than those in other patients. rSO2 measured by tNIRS-1 was higher in the toddler group than those in the other groups. The rSO2 values of tNIRS-1 and INVOS 5100C were moderately correlated (r = 0.41); however, those of INVOS 5100C were approximately 20% higher, and a ceiling effect was observed. The values in INVOS 5100C and tNIRS-1 were affected by blood pressure and the minimum alveolar concentration of sevoflurane, respectively. In pediatric patients undergoing non-cardiac surgery, rSO2 values differed across the three age groups, and the pattern of these differences varied between the two oximeters employing different algorithms. Further research must be conducted to clarify cerebral oxygenation in children.

Extracorporeal membrane oxygenation in children with oncohematological diseases

Extracorporeal membrane oxygenation in children with oncohematological diseases

Airway management with Hi-flow nasal cannula oxygen in children with severe laryngeal obstruction

BackgroundThe aim of this study was to report our initial experience in airway management in young children with severe laryngeal obstruction. Hi-flow nasal cannula oxygen (HFNO) with spontaneous respiration was used as a new airway management strategy in young children undergoing suspension laryngoscopic surgery. MethodsChildren aged between 1 day and 24 months scheduled for suspension laryngoscopy were retrospectively studied. The data collected included the patients' age, gender, American Society of Anaesthesiologists physical status classification, comorbidities, preoperative physiological status, methods of induction and maintenance of anesthesia, course of the disease and surgical options, lowest oxygen saturation recorded, transcutaneous CO2, duration of operation, and patients' need for rescue methods. ResultsA total of 38 patients successfully underwent suspension laryngoscopy under HFNO with spontaneous respiration. 19 patients were less than 1 year old (7 neonates), while the other half were less than or equal to 2 years old. The median [IQR (range)] lowest oxygen saturation recorded during the operation was 98 [93–99 (91–99)] %. The median [IQR (range)] duration of HFNO with spontaneous respiration was 65 [45–100 (30–200)] minutes. The median [IQR (range)] PCO2/PtcCO2 at the end of the spontaneous ventilation period was 54 [48–63 (39–70)] mmHg, which was the same as the preoperative PCO2 despite a long operation time. ConclusionsHFNO with spontaneous respiration emerged as a new airway management strategy in young children with severe laryngeal obstruction that was beneficial in maintaining oxygenation and was superior to transnasal humidified rapid insufflation ventilatory exchange (THRIVE) in terms of the rising rate of PCO2 in these patients, thereby prolonging the safety time of the operation.

Metabolic rate in children and adolescents: Tabulate values for common activities and comparisons with standards and adult values

Metabolic rate is one of the important factors determining human thermal comfort. However, in current standards, metabolic rates are based on average values for adults and do not include values for children. Children are in a phase of growth and development, with different body characteristics and composition, and their metabolic rates may differ from those of adults. This can lead to inaccurate estimations of thermal sensation. This study analyzed an open database on children's oxygen consumption during daily activities to determine metabolic heat production and rate for ages 6–18. Age and gender significantly influence the metabolic heat production (W) of children and adolescents. As individuals grow older, their metabolic heat production increases, with boys consistently showing higher values than girls. Using segmented regression analysis, the turning points of metabolic heat production growth in children and adolescents during watching television and walking activities were identified. It was determined that girls reach a stable state earlier than boys. Regarding metabolic rate (W/m2), the impact of gender and age varies across different activities but is generally modest. Males tend to have higher metabolic rates than females, and this difference tends to increase with age and activity. Throughout the entire age range, the metabolic rate remains relatively stable, without any significant inflection point observed. To optimize thermal environment designs in primary and middle schools, standards should focus on children and adolescents' specific metabolic data across genders and ages for common activities. Incorporating these reference values is crucial for designer guidelines and standards.

Cognition and education benefits of increased hemoglobin and blood oxygenation in children with sickle cell disease.

Among individuals with sickle cell disease (SCD), decreased hemoglobin is associated with lower oxygen saturation (SpO2) and increased risk of stroke, both of which are associated with lower intelligence quotient (IQ) scores. Thus, increasing hemoglobin and SpO2 in individuals with SCD may increase IQ and educational attainment. A cohort simulation model was built to determine academic performance and educational attainment based on cognitive function (measured by IQ) of a pediatric SCD cohort randomly assigned to treatment and control groups. The model contained two key stages: childhood (<10 years) and adolescence (≥10 years). In stage 1, increased hemoglobin and increased SpO2 (assigned to the treatment group) were determinants of higher IQ, prevention of IQ deterioration over time. Increased hemoglobin was also a determinant of decreased stroke risk. In stage 2, improvement in adolescent IQ as a result of treatment was a determinant of academic performance. In a simulated cohort of 2000 children and adolescents with SCD (52.5% female, 50% treated), stroke incidence was predicted to be 44.4% lower among the treated group than the untreated group (4.5% versus 8.1%, respectively). The average IQ among the treated group was estimated to be 91.1 compared with 82.9 in the untreated group (a 9.9% difference; P<0.001). Finally, high school (≥12 years of education) completion rates were estimated to be 64.7% higher among the treated group: 76.1% of the treated group was projected to complete high school compared with 46.2% of the untreated group. Our model predicts that an average improvement in hemoglobin of 1.1 g/dL (11 g/L) among individuals with SCD may be associated with improved neurocognition and educational outcomes. These improvements may also generate benefits not captured by our model, including improved quality of life, employment, and income.

Oxygenation Needs of the Bronchopneumonia Patient in the Pediatric Room at Parepare Hospital, Parepare City, Indonesia

This is the state inflammation of the walls bronchioles and tissues surrounding lung. Bronchopneumonia can call as lobular pneumonia Because inflammation of the parenchyma of lungs characteristic localized to the bronchioles along with the alveoli around it. This study aims to know description about fulfillment need oxygenation of the patient child with case Bronchopneumonia at general hospital area of Andi Makkasau Hospital city parepare. The sample use sheet observation in children with case bronchopneumonia use method descriptive describing studies case with patient that is men and boys in the House Sick General area and makkasau city parepare, with amount sample 2 people. Research results for patient 1 compliance need oxygenation in bronchopneumonia patients is fulfilled whereas in patient 2 with fulfillment need oxygenation in bronchopneumonia patients is not fulfilled. The results of this study show patient and family patient expected knowing about fulfillment oxygenation in children with cases of bronchopneumonia and can maintain action care nursing that has given.

Transnasal Humidified Rapid Insufflation Ventilatory Exchange Augments Oxygenation in Children With Juvenile Onset Recurrent Respiratory Papillomatosis During Surgery: A Prospective Randomized Crossover Controlled Trial.

Evidence is lacking regarding the efficacy of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) in tubeless anesthesia, especially in pediatric patients. This study aimed to evaluate the use of THRIVE for juvenile onset recurrent respiratory papillomatosis (JORRP) patients. Twenty-eight children aged 2 to 12 years with JORRP, abnormal airways, and ASA physical status II-III that presented for surgical treatment under general anesthesia were included in this study. Each patient received 2 interventions in random order, with a 5-minute washout period between treatments: apnea without oxygen supplementation and apnea with THRIVE intervention. The primary outcome apnea time was defined as the duration from withdrawal of intubation to reintubation and resumption of controlled ventilation. The secondary outcomes were the mean transcutaneous carbon dioxide (tcco2) increase rate, the minimum pulse oxygen saturation (Spo2) during apnea, and the occurrence of unexpected adverse effects. The median apnea time in the THRIVE period was significantly longer than that in the control period (8.9 [8.6-9.4] vs 3.8 [3.4-4.3] minutes; mean difference [95% confidence interval (CI)], 5.0 [4.4-5.6]; P < .001) for all patients. The rate of CO2 change in the control period was higher than that in the THRIVE period both for patients aged 2 to 5 years old (6.29 [5.19-7.4] vs 3.22 [2.92-3.76] mm Hg min-1; mean difference [95% CI], 3.09 [2.27-3.67]; P < .001) and for patients aged 6 to 12 years old (4.76 [3.7-6.2] vs 3.38 [2.64-4.0] mm Hg min-1; mean difference [95% CI], 1.63 [0.75-2.56]; P < .001). The minimum Spo2 was significantly higher in the THRIVE period than in the control period (mean difference [95% CI], 19.7 [14.8-22.6]; P < .001). Our findings demonstrate that THRIVE safely increased the apnea time among children with JORRP undergoing surgery and decreased the rate of carbon dioxide increase. THRIVE is clinically recommended as an airway management technique for tubeless anesthesia in apneic children.

Decreasing Inappropriate Supplemental Oxygen With High-Flow Nasal Cannula for Bronchiolitis.

Bronchiolitis is a leading cause of pediatric hospitalization. Treatment focuses on supportive care including supplemental oxygen for hypoxemia. High-flow nasal cannula (HFNC) has emerged as a modality to provide respiratory support with or without supplemental oxygen. At a freestanding children's hospital, inappropriate supplemental oxygen was frequently used. This study aimed to decrease the proportion of patients started on supplemental oxygen without documented hypoxemia from ∼90% to <70% and the proportion of patients weaned from HFNC without supplemental oxygen to nasal cannula with supplemental oxygen from ∼23% to <10%. A multidisciplinary taskforce was convened to develop an evidence-based protocol for HFNC usage. Data collection was obtained among patients aged <2 years admitted with bronchiolitis from September 2018 to September 2021. Institution-wide protocol changes occurred in November 2019 and October 2020, with ongoing education and evaluation. Data were summarized using statistical process control charts. Following implementation of a revised protocol in October 2020, the percentage of patients without documented hypoxemia (defined as an oxygen saturation <90% on pulse oximetry) who were inappropriately started on supplemental oxygen decreased from a baseline of 90.2% to 57.2%. At the same time, the percentage of patients weaned from HFNC without nasal cannula oxygen decreased from a baseline of 23.1% to 4.7%. Using supplemental oxygen in the absence of hypoxemia in bronchiolitis is an example of low-value care. Implementation of focused, standardized protocols with concurrent education can feasibly decrease inappropriate and unnecessary use of supplemental oxygen in children with bronchiolitis.

Cardiovascular abnormalities in chest radiographs of children with pneumonia, Uganda.

To describe chest radiograph findings among children hospitalized with clinically diagnosed severe pneumonia and hypoxaemia at three tertiary facilities in Uganda. The study involved clinical and radiograph data on a random sample of 375 children aged 28days to 12years enrolled in the Children's Oxygen Administration Strategies Trial in 2017. Children were hospitalized with a history of respiratory illness and respiratory distress complicated by hypoxaemia, defined as a peripheral oxygen saturation (SpO2) < 92%. Radiologists blinded to clinical findings interpreted chest radiographs using standardized World Health Organization method for paediatric chest radiograph reporting. We report clinical and chest radiograph findings using descriptive statistics. Overall, 45.9% (172/375) of children had radiological pneumonia, 36.3% (136/375) had a normal chest radiograph and 32.8% (123/375) had other radiograph abnormalities, with or without pneumonia. In addition, 28.3% (106/375) had a cardiovascular abnormality, including 14.9% (56/375) with both pneumonia and another abnormality. There was no significant difference in the prevalence of radiological pneumonia or of cardiovascular abnormalities or in 28-day mortality between children with severe hypoxaemia (SpO2: < 80%) and those with mild hypoxaemia (SpO2:80 to < 92%). Cardiovascular abnormalities were relatively common among children hospitalized with severe pneumonia in Uganda. The standard clinical criteria used to identify pneumonia among children in resource-poor settings were sensitive but lacked specificity. Chest radiographs should be performed routinely for all children with clinical signs of severe pneumonia because it provides useful information on both cardiovascular and respiratory systems.

Low-flow oxygen delivery using a nasal cannula for apnoeic oxygenation in children undergoing elective surgery under general anaesthesia

BACKGROUND Children have a smaller functional residual capacity and higher rate of oxygen consumption making them prone to develop hypoxaemia during a period of apnoea. The effectiveness of apnoeic oxygenation in preventing oxygen desaturation during laryngoscopy and intubation in small children has not been well studied. OBJECTIVE To assess the effectiveness of apnoeic oxygenation using a nasal cannula in preventing oxygen desaturation during laryngoscopy and intubation in children. DESIGN Prospective randomised double-blind controlled trial. SETTING Tertiary care teaching hospital between January 2020 and September 2021. PATIENTS One hundred and twenty children of 1 to 6 years age undergoing elective surgery requiring general anaesthesia with endotracheal intubation. INTERVENTION Patients were randomly allocated to receive 3 l min−1 oxygen by nasal cannula (apnoeic oxygenation group) or no oxygen (control group). Laryngoscopy and intubation was undertaken by a trainee anaesthesiologist. MAIN OUTCOME MEASURES The primary outcome was the lowest value of peripheral oxygen saturation (SpO2) during laryngoscopy and intubation. Secondary outcomes were the number of children whose SpO2 dropped to 95%, from 92% to &lt; 95%, and below 92% and the incidence of bradycardia. RESULTS The mean ± SD of lowest SpO2 values was 99.95 ± 0.29% in the apnoeic oxygenation group and 98.37 ± 4.60% in the control group (P = 0.009). No fall of SpO2 occurred in any patient in the apnoeic oxygenation group in spite of a longer apnoea time (P = 0.012). In the control group, 43 patients had no fall in SpO2 (P &lt; 0.001), in 12 patients there was a fall in SpO2 to 95% (P = 0.004), in one patient SpO2 fell to 92 to &lt;95% (P = 0.315) and in four patients SpO2 fell below 92% (P = 0.038). There was no incidence of bradycardia. CONCLUSION Apnoeic oxygenation using a nasal cannula was effective in preventing oxygen desaturation during laryngoscopy and intubation in children as compared with those who did not receive apnoeic oxygenation. TRIAL REGISTRATION Clinical Trials Registry of India: CTRI/2020/01/022724 (www.ctri.nic.in).

The effect of hyperventilation versus normoventilation on cerebral oxygenation using near infrared spectroscopy in children undergoing posterior fossa tumor resection: A randomized controlled cross-over trial

BackgroundThis study aims to compare the effect of two different ventilation strategies on cerebral oxygenation in children undergoing posterior fossa tumor excision surgeries. MethodsChildren scheduled for posterior fossa tumor surgeries were enrolled in this randomized, double-blinded, controlled cross-over trial. After induction of general anesthesia and positioning, participants were randomized to have mild hyperventilation for 30 min (phase 1) followed by normal ventilation for another 30 min (phase2) (early hyperventilation group, n = 23), or normal ventilation for 30 min (phase 1) followed by hyperventilation for 30 min (phase 2) (early normoventilation group, n = 19). Our primary outcome was cerebral oxygenation, measured using near-infrared spectroscopy (NIRS). Other outcomes included the intracranial pressure (ICP), brain relaxation score at the end of phase 1, and frequency of nadir NIRS. ResultsForty-two children were available for final per protocol analysis. The cerebral oxygenation decreased after the hyperventilation phase compared to the baseline values and the corresponding phases of normoventilation. The mean difference [95% confidence intervals (CI)] in cerebral oxygen saturation between the hyperventilation and normal ventilation readings was 13.45 ± 1.14% [11.14–15.76] and 11.47 ± 0.96% [11.14–15.76] in the left and right sides, respectively (p-values <0.0001). Both carryover and period effects were not significant. The ICP at the end of phase 1 did not differ between the two groups: 22.12 ± 3.75 mmHg vs. 23.26 ± 4.33, mean difference [95%CI]: −0.78 [−3.05 to 1.5], p = 0.49. Brain relaxation score was similar in the two groups. ConclusionIn children undergoing posterior fossa craniotomy, moderate hyperventilation reduced cerebral oxygenation without significant improvement of the surgical brain relaxation or the ICP.

The Local and Systemic Exposure to Oxygen in Children With Severe Bronchiolitis on Invasive Mechanical Ventilation: A Retrospective Cohort Study.

Oxygen supplementation is a cornerstone treatment in critically ill children with bronchiolitis in the PICU. However, potential deleterious effects of high-dose oxygen are well-known. In this study, we aim to describe the pulmonary (local) and arterial (systemic) oxygen exposure over the duration of invasive mechanical ventilation (IMV) in children with severe bronchiolitis. Our secondary aim was to estimate potentially avoidable exposure to high-dose oxygen in these patients. Retrospective cohort study. Single-center, tertiary-care PICU. Children younger than 2 years old admitted to the PICU for severe bronchiolitis receiving IMV. None. Hourly measurements of Fio2 and peripheral oxygen saturation (Spo2), and arterial blood gas data were collected up to day 10 of IMV. A total of 24,451 hours of IMV were observed in 176 patients (median age of 1.0 mo [interquartile range (IQR), 1.0-2.3 mo]). The pulmonary exposure to oxygen was highest during the first day of IMV (median time-weighted average [TWA]-Fio2 0.46 [IQR, 0.39-0.53]), which significantly decreased over subsequent days. The systemic exposure to oxygen was relatively low, as severe hyperoxemia (TWA-Pao2 > 248 Torr [> 33 kPa]) was not observed. However, overuse of oxygen was common with 52.3% of patients (n = 92) having at least 1 day of possible excessive oxygen exposure and 14.8% (n = 26) with severe exposure. Furthermore, higher oxygen dosages correlated with increasing overuse of oxygen (rrepeated measures, 0.59; 95% CI, 0.54-0.63). Additionally, caregivers were likely to keep Fio2 greater than or equal to 0.50 when Spo2 greater than or equal to 97%. Moderate to high-dose pulmonary oxygen exposure and potential overuse of oxygen were common in this cohort of severe bronchiolitis patients requiring IMV; however, this was not accompanied by a high systemic oxygen burden. Further studies are needed to determine optimal oxygenation targets to prevent overzealous use of oxygen in this vulnerable population.

Expert consensus on inter-hospital transport of extracorporeal membrane oxygenation in children (version 2022)

危重症患儿由于诊疗的需求，常面对极大的转运风险。与成人相比，儿童危重症院际转运是一项极具挑战性的工作。近年来，体外膜氧合（ECMO）技术广泛应用于常规治疗无效的儿童急性呼吸和（或）循环衰竭，并在院际转运救治中发挥着不可替代的作用，但国内尚无适用于儿童的ECMO院际转运技术规范或共识指南。依据国内开展经验，并结合国外相关研究，从儿童ECMO院际转运的各个环节形成本共识，以指导临床实践，提高ECMO转运安全性。.