Paediatric anaesthesia & critical care
Effectiveness of nasal high-flow oxygen during apnoea on hypoxaemia and intubation success in paediatric emergency and ICU settings: a randomised, controlled, open-label trial
Primary result · Hypoxaemic events (SpO2 ≤90%)Result — go to the resultAdjusted odds ratio 0.74 97.5% CI 0.46–1.18Authors' conclusion
The use of NHF during emergency intubation in children did not result in a reduction in hypoxaemic events or an increase in the frequency of successful intubation on the first attempt.
Study context
- Population
- Children younger than 16 years undergoing emergency endotracheal intubation; EDs, PICUs and one neonatal ICU at ten hospitals in Australia, New Zealand and Switzerlandintubations in 969 children
- Participants
- 1,069 participants
- Comparison
- Nasal high-flow (NHF) apnoeic oxygenation vs standard care during intubation
- NHFn = 535
- Standard caren = 534reference
- Primary endpoint
- Co-primary: hypoxaemic events (SpO2 ≤90%) and successful first-attempt intubation without desaturation
Methodological detailsopen-label, multicentre
- Open-label
- Multicentre
Primary result
Hypoxaemic events (SpO2 ≤90%)
Adjusted odds ratio
0.74
97.5% CI 0.46–1.18
P = 0.15
Events by treatment group
NHF vs Standard care
aOR 0.74 (97.5% CI 0.46–1.18); P = 0.15
As reported in the abstract
Further findings
| Outcome | NHF | Standard care | Estimate | P value | |
|---|---|---|---|---|---|
| Successful first-attempt intubation (co-primary outcome)Modified ITT population | 63.0% | 59.1% | aOR for successful first-attempt intubation 1.13 (97.5% CI 0.79–1.62) | P = 0.43 | |
| Hypoxaemic events (per-protocol analysis) | 10.8% | 16.7% | aOR for hypoxaemic events 0.59 (97.5% CI 0.36–0.97) | P = 0.017 | |
| Successful first-attempt intubation (per-protocol analysis)Per-protocol analysis | 64.0% | 58.1% | aOR for successful first-attempt intubation 1.22 (97.5% CI 0.87–1.71) | P = 0.19 | |
| 0.20.5125Ratio (log scale) |
- Hypoxaemic events (per-protocol analysis): per-protocol analysis of 905 intubations
Original publication
Effectiveness of nasal high-flow oxygen during apnoea on hypoxaemia and intubation success in paediatric emergency and ICU settings: a randomised, controlled, open-label trial. Lancet Respir Med. Published 21 March 2025. doi:10.
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