(852) Should We Hold Our Breath? Apneic Time During Pediatric Intubation

Introduction: Apneic time during laryngoscopy in tracheal intubation (TI) poses high risk to critically ill children. It is not known what the actual apneic time during laryngoscopy is in the current practice and what factors are associated with longer apneic time during laryngoscopy. We hypothesize patient age, laryngoscopist type, and use of video laryngoscope (VL) are associated with apneic time, and longer apneic time is significantly associated with oxygen desaturation.

Methods: This study was conducted in two phases pre and post VL implementation at a large academic pediatric ICU. During the first phase, a research member directly observed TI. During the second phase, respiratory function monitor captured the apneic time during laryngoscopy. Inclusion criteria: child < 18 years, oral intubations. Apneic time was dichotomized using median value. Patient, Provider, Practice variables were obtained from a local TI database. Analysis by Fisher Exact and Wilcoxon rank-sum.

Results: A total of 112 TIs (first phase 29, second phase 83), including 147 attempts with apneic time data. Laryngoscopy apneic time was median 53.2 sec (IQR: 42.0-78.8). Using the median time as a cutoff, longer apneic time was significantly more common in younger (1-7y) children (46%) than infants (32%) or older children (22%), p=0.04. The proportion of longer apneic time was not different between TIs in children with or without difficult airway history (50% vs. 52%, p=1.00), by laryngoscopist (Attending 60%, Fellows 49%, Resident 50%, Nurse practitioner 52%, p=0.96), or use of VL (VL 44% vs. DL 43%, p=0.21). Magnitude of SpO2 drop during apneic time was not different between TIs with longer vs. shorter apneic time (median 0, IQR 0-0 for both, p=0.84). There was no significant difference in apneic times associated with SpO2 < 90% (18.4% vs 9.9%, p=0.16) or SpO2 < 80% (10.5% vs 8.5%, p=0.78).

Conclusions: Patient age, but not history of difficult airway, laryngoscopist type, or VL use, was associated with longer apneic time during laryngoscopy. In this convenience sample, there was no significant difference in the rate or magnitude of desaturation between TIs with longer vs. shorter apneic time during laryngoscopy.