Apneic Oxygenation in the Pediatric Intensive Care Unit
Condition: Intubation Complication
Study type: Interventional

Summary: 
      The purpose of the study is to determine the impact of apneic oxygenation on the time to
      desaturation in pediatric patients treated in a pediatric intensive care unit (PICU). The
      investigators hypothesize pediatric patients will have an increase in time to desaturation
      with apneic oxygenation when compared to standard practice in the PICU.
    

Detailed description: 
      Oxygen (O2) desaturation is one of the risks of intubation, especially in critically ill
      children with comorbidities, increased O2 consumption and decreased O2 delivery. Desaturation
      places patients at greater risk for dysrhythmia, hemodynamic instability, hypoxic brain
      injury, and death. As shown in the oxyhemoglobin dissociation curve, once oxyhemoglobin
      (PaO2) saturations drop to ~ 90%, there is an increased risk for precipitous desaturation.

      Although many may believe there would be no gas exchange during apnea, alveoli continue to
      take up oxygen even without diaphragmatic movements or lung expansion. As such, the
      administration of oxygen during intubation (when a patient is apneic) has not been a standard
      practice until recently.

      Recent studies in adults have shown an increase in the time to desaturation when they are
      given concurrent oxygen administration during an intubation attempt. This use of oxygen
      during intubation is referred to as apneic oxygenation.

      As a result of this work, apneic oxygenation has become standard practice in many emergency
      departments, even with pediatric patients. Yet, in pediatric hospital units, including
      intensive care, this is not the standard practice and no pediatric studies have been
      published on this subject to date.

      In the study unit apneic oxygenation is not standard during intubation. The investigators
      would like to evaluate its use as it has shown benefits in prior research published on
      adults. Most patients in the PICU are already on a source of oxygen administration prior to
      intubation, this source of oxygen is usually removed during the intubation attempt, when the
      patient is apneic and not breathing on his/her own.

      Continuing oxygen administration during the apneic period, would be a minimal to no risk
      intervention and has only shown a benefit during the apneic period.

      For this protocol:

      Once a decision is made for intubation, the subject will be randomized into one of two
      groups:

        1. Control (standard practice)

        2. Apneic oxygenation.

      Randomization: Subjects will be stratified by age (0 - 2 years and >2 - 17), randomized in
      blocks of 10 until the final sample size is achieved.

      For all subjects, the study protocol will determine only the provision of supplemental oxygen
      during intubation.

      Decisions regarding the intubation approach, pre-oxygenation, patient positioning,
      medications used, ventilation strategy, and choice of equipment will be made by the clinical
      team.

      Because of the nature of the study intervention, clinicians and study personnel will be aware
      of study group assignments after randomization.
    

Intervention name(s): Apneic Oxygenation
Intervention type(s): Procedure
Intervention description(s): Supplemental oxygen will be provided via nasal cannula during intubation attempt
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention