JournalFeed PubMetric Report
Analysis Source: PDF full text + PubMed metadata
JournalFeed PubMetric Score
High Confidence
PubMetric Score Breakdown
Findings are relevant to pediatric critical care and airway management.
Prospective observational design with direct observation and video review.
Some concerns due to convenience sampling and potential selection bias.
Statistically significant reduction in desaturation with apneic oxygenation.
Single-center study; results need further validation.
Apneic oxygenation can be easily implemented in clinical settings.
Funding present; COI disclosure present.
Critical Appraisal
Study Identification
Background
Study Question
Study Design & Conduct
Prospective / Retrospective: Prospective
Multicenter: No
Unit of Allocation: Not applicable
Unit of Analysis: Tracheal intubations
Randomization Method: Not applicable
Allocation Concealment: Not applicable
Blinding: Not applicable
Follow-up Duration: Not reported
Population
- Children under 18 years
- Undergoing primary oral tracheal intubation in PICU or ED
- Missing data on apneic time or oxygen saturation
- Nasal intubations
- Pre-existing tracheostomies
- Emergency resuscitation cases with unreliable data
Number Enrolled: 204
Number Analyzed: 204
Key Baseline Characteristics
Sex: Not reported
Disease Severity: Not reported
Care Setting Distribution: PICU and ED
Additional Baseline Characteristics
- Infants more likely to have long apneic times
Exposures / Interventions
Description: Measurement of apneic time during tracheal intubation
Definition / Dose: 54-second cutoff for long apneic time
Timing: During tracheal intubation
Classification Method: Direct observation and video review
Protocolized / Discretionary: Protocolized
Description: Short apneic time and no apneic oxygenation
Definition: Apneic time ≤54 seconds and absence of apneic oxygenation
Outcomes & Results
Primary Outcomes
Definition: SpO₂ <90% during the apneic period
Time Point: During tracheal intubation
Measurement Method: SpO₂ measurement
Results: No significant association with long apneic time
Secondary Outcomes
Definition: Drop in SpO₂ from highest to lowest during apneic period
Time Point: During tracheal intubation
Measurement Method: SpO₂ measurement
Results: Median degree of desaturation was 0% in both groups
Risk of Bias
Risk of Bias - ROBINS-I
- Confounding (Some concerns): Potential confounders like comorbidities and preparation before intubation were not fully accounted for.
- Selection of participants (Low): Participants were selected based on clear inclusion criteria.
- Classification of interventions (Low): Interventions were clearly defined and consistently applied.
- Deviations from intended interventions (Low): Interventions were applied as intended without deviations.
- Missing data (Some concerns): Exclusions due to missing data could introduce bias.
- Measurement of outcomes (Low): Outcomes were measured using standardized methods.
- Selection of the reported result (Low): All relevant outcomes were reported.
Transparency
COI Statement Present: TRUE
PubMetric Brief
Take-Home Message
Apneic oxygenation reduces desaturation risk during pediatric intubation.
Study Summary
This prospective observational study evaluated 204 tracheal intubations in critically ill children under 18 years in a pediatric intensive care unit and emergency department. The study aimed to identify factors associated with long apneic times and their relationship with oxygen desaturation. Apneic time was categorized as short or long using a 54-second cutoff. Results showed that infants were more likely to experience long apneic times, but there was no significant association between long apneic time and oxygen desaturation. However, the use of apneic oxygenation significantly reduced the risk of desaturation, with an adjusted odds ratio of 0.17 (95% CI 0.07–0.43, p<0.001).
Citation
Apneic time during intubation in critically ill children
. Pediatric research. 2026. PMID: 41530490