Evidence map›Paper›PMID 36650568›Full record

ArticleCritical care (London, England)2023

Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.

Natalie Napolitano, Lee Polikoff, Lauren Edwards, Keiko M Tarquinio, Sholeen Nett, Conrad Krawiec, Aileen Kirby, Nina Salfity, David Tellez, Gordon Krahn and 7 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
8.3field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 24 citations in OpenAlex.

  1. Trial
  2. Observational
  3. Tracheal Intubation by Attending Physicians in a U.S. Registry, 2016-2020: Analysis by PICU Participation in a Skills Maintenance Program and Fellowship Training.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2025
    Article
  4. Article
  5. Review
  6. Article
  7. Article
  8. Review
  9. Article
  10. Article
  11. Delayed Sequence Intubation in Children, Why Not?Saudi journal of medicine & medical sciences
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 12 institutions in 2 countries.

Natalie Napolitano *Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA, USA. napolitanon@chop.edu.
Lee Polikoff *Division of Pediatric Critical Care Medicine, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Lauren EdwardsDivision of Critical Care, Department of Pediatrics, Children's Healthcare of Atlanta, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, USA.
Keiko M TarquinioDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Sholeen NettDivision of Pediatric Critical Care, Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Conrad KrawiecDivision of Pediatric Critical Care Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.
Aileen KirbyDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA.
Nina SalfityDepartment of Critical Care, Phoenix Children's Hospital, Phoenix, AZ, USA.
David TellezDepartment of Critical Care, Phoenix Children's Hospital, Phoenix, AZ, USA.
Gordon KrahnDivision of Pediatric Critical Care, University of British Columbia, Vancouver, BC, Canada.
Ryan BreuerDivision of Pediatric Critical Care, Oishei Children's Hospital, Buffalo, NY, USA.
Simon J ParsonsDivision of Critical Care, Alberta Children's Hospital, Calgary, Canada.
Christopher Page-GoertzDivision of Critical Care Medicine, Akron Children's Hospital, Akron, OH, USA.
Justine ShultsDivision of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Vinay NadkarniDivision of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Akira NishisakiDivision of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
for National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Children's Hospital of Philadelphia · USPhoenix Children's Hospital · USAkron Children's Hospital · USAlberta Children's Hospital · CABrown University · USChildren's Healthcare of Atlanta · USDartmouth–Hitchcock Medical Center · USDoernbecher Children's Hospital · USEmory University · USPenn State Milton S. Hershey Medical Center · USUniversity of British Columbia · CAWomen & Children's Hospital of Buffalo · US

Funding

Agency for Healthcare Research and Quality R18HS024511
6 · The paper itself

Abstract

backgroundDetermine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI), reduces adverse TI-associated events (TIAEs) in children.

methodsAO was implemented across 14 pediatric intensive care units as a quality improvement intervention during 2016-2020. Implementation consisted of an intubation safety checklist, leadership endorsement, local champion, and data feedback to frontline clinicians. Standardized oxygen flow via nasal cannula for AO was as follows: 5 L/min for infants (< 1 year), 10 L/min for young children (1-7 years), and 15 L/min for older children (≥ 8 years). Outcomes were the occurrence of adverse TIAEs (primary) and hypoxemia (SpO

resultsOf 6549 TIs during the study period, 2554 (39.0%) occurred during the pre-implementation phase and 3995 (61.0%) during post-implementation phase. AO utilization increased from 23 to 68%, p < 0.001. AO was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patient intubated due to respiratory or neurological failure or shock. Conversely, AO was used more often in TIs done for procedures and those assisted by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%, p < 0.001), aOR 0.75 (95% CI 0.58-0.98, p = 0.03) after adjusting for site clustering (primary analysis). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs: aOR 0.90, 95% CI 0.72-1.12, p = 0.33 and the occurrence of hypoxemia was not different: AO 14.2% versus without AO 15.2%, p = 0.43.

conclusionWhile AO use was associated with a lower occurrence of adverse TIAEs in children who required TI in the pediatric ICU after accounting for site-level clustering, this result may be explained by differences in patient, provider, and practice factors. Trial Registration Trial not registered.

Indexed as

Critical IllnessIntubation, IntratrachealChildChild, PreschoolHumansHypoxiaInfantOxygenRespiration, ArtificialOxygenAirwayApneic oxygenationHypoxemiaPediatricsTracheal intubation

Identifiers

PMID36650568
PMCPMC9847056
OpenAlexW4317035511

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.