AI Article Synopsis

  • Tracheobronchial endoscopy in toddlers under general anesthesia can lead to acute hypoxemia, which may affect patient outcomes, prompting the need for better monitoring during the procedure.
  • A study analyzed 96 endoscopic procedures from 2015 to 2018, revealing that 58% of cases experienced at least one low oxygen saturation episode, with a median hypoxic burden of 25%.
  • Factors such as initial admission to general hospitals and the use of topical lidocaine for airway anesthesia were linked to lower risks of high hypoxic burden, which in turn correlated with increased chances of requiring invasive ventilation post-procedure and extended hospital stays.

Article Abstract

Tracheobronchial endoscopy with general anaesthesia for suspected foreign body aspiration exposes toddlers to acute hypoxemia. Better quantification of intraoperative hypoxemia could help identify and manage the most severe patients. We explored the hypoxic burden approach to account for both duration and depth of desaturation episodes during the procedure and determined risk factors for high hypoxic burden. We retrospectively analysed tracheobronchial endoscopies performed from September 2015 to September 2018 in children ≤ 36 months for suspected foreign body aspiration, in two French university hospitals. The hypoxic burden (area under 90% of the SpO/time curve) was calculated. The median of non-zero burdens was used to delineate a subgroup with high hypoxic burden. Risk factors for high hypoxic burden were identified using multivariable analysis. Of 96 procedures, 56 (58%) were associated with at least one SpO value < 90%. Of them, the median [interquartile] hypoxic burden was 25 [5-87] %.min. Bradycardia < 100 bpm occurred in 11 procedures (11%). Initial admission to general hospitals (OR 0.23, 95% CI 0.06-0.86) and airway anaesthesia with topical lidocaine (OR 0.15, 95% CI 0.03-0.62) were associated with a reduced risk of high hypoxic burden. High hypoxic burden was associated with an increased risk of postoperative invasive ventilation (OR 32, 95% CI 1.7-617) and of hospital stay > 24 h (OR 4.0, 95% CI 1.6-10). No postoperative neurological sequelae were found. The hypoxic burden approach, when applied in tracheobronchial endoscopy for suspected foreign body aspiration in toddlers, enabled the quantification of hypoxemia and the search for specific risk factors.

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http://dx.doi.org/10.1007/s10877-020-00559-yDOI Listing

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