Eur J Anaesthesiol. 2024 Sep 1;41(9):687-694. doi: 10.1097/EJA.0000000000002018. Epub 2024 May 27.
ABSTRACT
BACKGROUND: Hypoxaemia occurs frequently during paediatric laryngeal microsurgery.
OBJECTIVE: The oxygen reserve index is a noninvasive and continuous parameter to assess PaO2 levels in the range of 100 to 200 mmHg. It ranges from 0 to 1.0. We investigated whether monitoring the oxygen reserve index can reduce the incidence of SpO2 90% or less.
DESIGN: Randomised controlled trial.
SETTING: A tertiary care paediatric hospital.
PARTICIPANTS: Paediatric patients aged 18 years or less scheduled to undergo laryngeal microsurgery.
INTERVENTION: The patients were randomly allocated to the oxygen reserve index or control groups, and stratified based on the presence of a tracheostomy tube. Rescue intervention was performed when the oxygen reserve index was 0.2 or less and the SpO2 was 94% or less in the oxygen reserve index and control groups, respectively.
MAIN OUTCOME MEASURE: The primary outcome was the incidence of SpO2 90% or less during the surgery.
RESULTS: Data from 88 patients were analysed. The incidence of SpO2 ≤ 90% did not differ between the oxygen reserve index and control groups [P = 0.114; 11/44, 25% vs. 18/44, 40.9%; relative risk: 1.27; and 95% confidence interval (CI): 0.94 to 1.72]. Among the 128 rescue interventions, SpO2 ≤ 90% event developed in 18 out of 75 events (24%) and 42 out of 53 events (79.2%) in the oxygen reserve index and control groups, respectively (P < 0.001; difference: 55.2%; and 95% CI 38.5 to 67.2%). The number of SpO2 ≤ 90% events per patient in the oxygen reserve index group (median 0, maximum 3) was less than that in the control group (median 0, maximum 8, P = 0.031).
CONCLUSION: Additional monitoring of the oxygen reserve index, with a target value of greater than 0.2 during paediatric airway surgery, alongside peripheral oxygen saturation, did not reduce the incidence of SpO2 ≤ 90%.
PMID:39087414 | DOI:10.1097/EJA.0000000000002018
