Green SM, Bhatt M, Roback MG. Supplemental Oxygen for Pediatric Procedural Sedation: Common Sense Precaution or False Reassurance? Ann Emerg Med. 2024 Jun 21:S0196-0644(24)00293-2. doi: 10.1016/j.annemergmed.2024.05.025. Epub ahead of print. PMID: 38912997.

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Editorial

Should we administer prophylactic supplemental oxygen for procedural sedation? Many clinicians and settings do so routinely, whereas many others do not. It may seem intuitive that this precaution should enhance safety, particularly in children whose oxygen reserves are more rapidly depleted than those of adults.

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Li J, Krauss B, Monuteaux MC, Cavallaro S, Fleegler E. Preprocedural Oxygenation and Procedural Oxygenation During Pediatric Procedural Sedation: Patterns of Use and Association With Interventions. Ann Emerg Med. 2024 Jun 12:S0196-0644(24)00223-3. doi: 10.1016/j.annemergmed.2024.04.014. Epub ahead of print. PMID: 38864784.

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Abstract
Study objective: Preprocedural oxygenation (pre-emptive oxygenation started during presedation and/or induction) and procedural oxygenation (pre-emptive oxygenation started during any phase of sedation) are easy-to-use strategies with potential to decrease adverse events. Here, we describe practice patterns of preprocedural oxygenation and procedural oxygenation. We hypothesized that patients who received preprocedural oxygenation or procedural oxygenation would have a lower risk of airway/breathing/circulation interventions during sedation compared with patients without procedural oxygenation.

Methods: We performed a retrospective, multicenter, cross-sectional study of pediatric sedations from April 2020 to July 2023 using the Pediatric Sedation Research Consortium multicenter database. The patient-level and sedation-level characteristics were described using frequencies and proportions, stratified by preprocedural oxygenation and procedural oxygenation status. We determined the site-level frequency of preprocedural oxygenation and procedural oxygenation use. We used inverse probability of treatment weighting to calculate the risk difference for interventions associated with preprocedural oxygenation and procedural oxygenation.

Results: This study included a total of 85,599 pediatric sedations; 43,242 (50.5%) patients received preprocedural oxygenation (used oxygen before sedation and/or at induction) and a total of 52,219 (61.0%) received procedural oxygenation pre-emptively at any time during the sedation. There was no statistical difference in overall interventions with either preprocedural oxygenation (risk difference -0.06%; 95% confidence interval -4.26% to 4.14%) or procedural oxygenation (risk difference -1.07%; 95% confidence interval -6.44% to 4.30%).

Conclusion: Pre-emptive preprocedural oxygenation and procedural oxygenation were not associated with a difference in the use of airway/breathing/circulation interventions in pediatric sedations.