Abstract
Background
Pulse oximetry (SpO2) is a flawed measure of adequacy of preoxygenation prior to intubation. The fraction
of expired oxygen (FeO2) is a promising but understudied alternative.
Objective
To investigate FeO2 as a measure of preoxygenation prior to intubation in a pediatric emergency department.
Methods
We conducted a prospective, observational study of patients 18 and younger. We collected
data using video review, and FeO2 was measured via inline sampling. The main outcomes were FeO2 and SpO2 at the start of preoxygenation, end of preoxygenation/start of intubation attempt,
and the end of intubation attempt. We compared FeO2 and SpO2 at the end of preoxygenation for patients with and without oxyhemoglobin desaturation.
Results
We enrolled 85 of 88 eligible patients during the 14-month study period. FeO2 data were available at the start of preoxygenation for 53 of 85 patients (62%), and
for the end of preoxygenation for 59 of 85 patients (69%). Median FeO2 at the start and end of preoxygenation was 90% (interquartile range [IQR] 88, 92)
and 90% (IQR 88, 92). Median SpO2 at the start and end of preoxygenation was 100% (IQR 100, 100). There were 11 episodes
of desaturation, with median FeO2 at the start of intubation attempt of 89.5 (IQR 54.5, 91.5) and median SpO2 of 100 (IQR 99, 100). Patients who did not have a desaturation event had a median
FeO2 of 90.0 (IQR 88.0, 92.0).
Conclusions
Measuring FeO2 during rapid sequence intubation is challenging with feasibility limitations, but
may be a more discriminatory metric of adequate preoxygenation.
Keywords
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Article info
Publication history
Published online: May 01, 2022
Accepted:
April 23,
2022
Received in revised form:
April 8,
2022
Received:
January 10,
2022
Footnotes
Presentations: This work was accepted as a poster presentation at the 2020 Pediatric Academic Societies Meeting; Philadelphia, PA, which was ultimately cancelled. It was subsequently presented virtually through the Academic Pediatric Association's mobile application. This work was presented as a platform presentation at the 2020 Resident and Fellows Acute Care Research Showcase, University of Cincinnati, College of Medicine, March 6, 2020. This work was also an accepted Abstract for presentation at the 2020 Society for Academic Emergency Medicine Annual Meeting in Denver, Colorado, which was ultimately cancelled.
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© 2022 Published by Elsevier Inc.
