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Oxygen desaturation and time burden during tracheobronchial endoscopy for suspected foreign body in toddlers

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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 SpO2/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 SpO2 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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Acknowledgements

The authors warmly thank Mr. Hugo Terrisse for his statistical advice. They also thank Bow Medical for helping us to extract SpO2 data.

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, Couple Enfant Hospital, Grenoble-Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France

    Sarah Aubanel, Blandine Camus, Jean-François Payen & Jean-Noël Evain

  2. Department of Anaesthesia and Intensive Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France

    Guillaume Izaute, Claire Gariel & Lionel Bouvet

  3. Department of Otolaryngology-Head and Neck Surgery, Couple Enfant Hospital, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France

    Ihab Atallah

  4. Department of Paediatric Otolaryngology-Head and Neck Surgery, Femme Mère Enfant Hospital, Hospices Civils de Lyon, 59 boulevard Pinel, 69500, Bron, France

    Sonia Ayari

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  1. Sarah Aubanel
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  2. Guillaume Izaute
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  3. Claire Gariel
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  4. Blandine Camus
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  7. Lionel Bouvet
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  8. Jean-François Payen
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  9. Jean-Noël Evain
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Contributions

SA, GI: Investigation, Writing—Original Draft. CG, BC, IA, SA: Writing—Review and Editing. LB, J-FP: Supervision, Writing—Review and Editing. J-NE: Conceptualization, Methodology, Formal analysis, Writing—Review and Editing.

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Correspondence to Jean-Noël Evain.

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The authors declare that they have no conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical statement

The study design was approved by the Ethics Committee of the French Society of Anaesthesia & Intensive Care Medicine (Institutional Review Board 00010254-2019-091) on June 23, 2019.

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Aubanel, S., Izaute, G., Gariel, C. et al. Oxygen desaturation and time burden during tracheobronchial endoscopy for suspected foreign body in toddlers. J Clin Monit Comput 35, 1077–1084 (2021). https://doi.org/10.1007/s10877-020-00559-y

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