Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.

Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would def...

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Autores principales:	Jayme Marques Dos Santos Neto, Clístenes Cristian de Carvalho, Lívia Barboza de Andrade, Thiago Gadelha Batista Dos Santos, Rebeca Gonelli Albanez da Cunha Andrade, Raphaella Amanda Maria Leite Fernandes, Flavia Augusta de Orange
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7e5eaf5341f348edb0a48b7d237a94c0
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spelling	oai:doaj.org-article:7e5eaf5341f348edb0a48b7d237a94c02021-12-02T20:13:51ZContinuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.1932-620310.1371/journal.pone.0256950https://doaj.org/article/7e5eaf5341f348edb0a48b7d237a94c02021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0256950https://doaj.org/toc/1932-6203Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would defer a SpO2 decrease to 95% after apnoea onset compared to the regular technique in which no positive airway pressure is applied. In this double-blind, parallel, randomised controlled clinical trial, 68 children aged 2-6 years with ASA I-II who underwent surgery under general anaesthesia were divided into CPAP and control groups (n = 34 in each group). The intervention was CPAP ventilation and passive CPAP oxygenation using an anaesthesia workstation. The primary outcome was the elapsed time until SpO2 decreased to 95% during a follow-up period of 300 s from apnoea onset (T1). We also recorded the time required to regain baseline levels from an SpO2 of 95% aided by positive pressure ventilation (T2). The median T1 was 278 s (95% confidence interval [CI]: 188-368) in the CPAP group and 124 s (95% CI: 92-157) in the control group (median difference: 154 s; 95% CI: 58-249; p = 0.002). There were 17 (50%) and 32 (94.1%) primary events in the CPAP and control groups, respectively. The hazard ratio was 0.26 (95% CI: 0.14-0.48; p<0.001). The median for T2 was 21 s (95% CI: 13-29) and 29 s (95% CI: 22-36) in the CPAP and control groups, respectively (median difference: 8 s; 95% CI: -3 to 19; p = 0.142). SpO2 was significantly higher in the CPAP group than in the control group throughout the consecutive measures between 60 and 210 s (with p ranging from 0.047 to <0.001). Thus, in the age groups examined, CPAP ventilation and passive CPAP oxygenation deferred SpO2 decrease after apnoea onset compared to the regular technique with no positive airway pressure.Jayme Marques Dos Santos NetoClístenes Cristian de CarvalhoLívia Barboza de AndradeThiago Gadelha Batista Dos SantosRebeca Gonelli Albanez da Cunha AndradeRaphaella Amanda Maria Leite FernandesFlavia Augusta de OrangePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0256950 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jayme Marques Dos Santos Neto Clístenes Cristian de Carvalho Lívia Barboza de Andrade Thiago Gadelha Batista Dos Santos Rebeca Gonelli Albanez da Cunha Andrade Raphaella Amanda Maria Leite Fernandes Flavia Augusta de Orange Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.
description	Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would defer a SpO2 decrease to 95% after apnoea onset compared to the regular technique in which no positive airway pressure is applied. In this double-blind, parallel, randomised controlled clinical trial, 68 children aged 2-6 years with ASA I-II who underwent surgery under general anaesthesia were divided into CPAP and control groups (n = 34 in each group). The intervention was CPAP ventilation and passive CPAP oxygenation using an anaesthesia workstation. The primary outcome was the elapsed time until SpO2 decreased to 95% during a follow-up period of 300 s from apnoea onset (T1). We also recorded the time required to regain baseline levels from an SpO2 of 95% aided by positive pressure ventilation (T2). The median T1 was 278 s (95% confidence interval [CI]: 188-368) in the CPAP group and 124 s (95% CI: 92-157) in the control group (median difference: 154 s; 95% CI: 58-249; p = 0.002). There were 17 (50%) and 32 (94.1%) primary events in the CPAP and control groups, respectively. The hazard ratio was 0.26 (95% CI: 0.14-0.48; p<0.001). The median for T2 was 21 s (95% CI: 13-29) and 29 s (95% CI: 22-36) in the CPAP and control groups, respectively (median difference: 8 s; 95% CI: -3 to 19; p = 0.142). SpO2 was significantly higher in the CPAP group than in the control group throughout the consecutive measures between 60 and 210 s (with p ranging from 0.047 to <0.001). Thus, in the age groups examined, CPAP ventilation and passive CPAP oxygenation deferred SpO2 decrease after apnoea onset compared to the regular technique with no positive airway pressure.
format	article
author	Jayme Marques Dos Santos Neto Clístenes Cristian de Carvalho Lívia Barboza de Andrade Thiago Gadelha Batista Dos Santos Rebeca Gonelli Albanez da Cunha Andrade Raphaella Amanda Maria Leite Fernandes Flavia Augusta de Orange
author_facet	Jayme Marques Dos Santos Neto Clístenes Cristian de Carvalho Lívia Barboza de Andrade Thiago Gadelha Batista Dos Santos Rebeca Gonelli Albanez da Cunha Andrade Raphaella Amanda Maria Leite Fernandes Flavia Augusta de Orange
author_sort	Jayme Marques Dos Santos Neto
title	Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.
title_short	Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.
title_full	Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.
title_fullStr	Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.
title_full_unstemmed	Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.
title_sort	continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: a double-blind randomised controlled trial.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/7e5eaf5341f348edb0a48b7d237a94c0
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Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.

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