Children with upper respiratory infections (URIs) are at greater risk of adverse events and airway interventions during procedural sedation – though the rates are low, researchers say.
Dr. Joseph Cravero of Boston Children’s Hospital in Massachusetts and colleagues analyzed data on 83,491 sedations in children with a mean age of 4.5 years (about 44 percent girls) performed between November 2012 and July 2015.
They looked at procedures done in children without a URI (70,830), with a recent URI (3,354), with current URI (8,649) and with a current URI with thick secretion (658).
Propofol was the most commonly used sedative in all groups, followed by ketamine. Opioid analgesics were given in 23.3 percent of cases, and were more commonly used in patients with no URI (P<0.001). Atropine and glycopyrrolate were administered to 2.7 percent and 6.5 percent of all children, respectively, regardless of URI status (P<0.001).
As reported in Pediatrics, online June 29, the rate of any adverse airway event – e.g., wheezing, cough, stridor, laryngospasm – increased progressively from 6.3 percent for those with no URI to 22.2 percent for those with current URI with thick and/or green secretions.
Similarly, most airway interventions – e.g., endotracheal tube, nasopharyngeal airway, suction – increased from no URI status to recent URI, to current URI with thin and/or clear secretions, and then to current URI with thick and/or green secretions.
A statistically significant association was seen between recent URI and current URI with thick and/or green secretions with seven of 10 adverse airway events when compared with no URI.
Current URI with thin and/or clear secretions had a statistically significant association with eight of 10 adverse airway events compared with no URI. Odds ratios varied for both sets of associations based on the characteristics and timing of the URIs.
“Although URI status merits consideration in determining potential risk for sedation,” the authors observe, rates of some adverse airway events and airway interventions were low regardless of URI status. Experts not involved in the study commented on the findings for Reuters Health.
Dr. Juan Gutierrez, director of the pediatric ICU at Atlantic Health System Goryeb Children’s Hospital in Morristown, New Jersey, said, “Ultimately, practitioners and parents should weigh the risk/benefit balance of any procedure. This study confirms the general safety of doing procedures under sedation in children with mild upper respiratory infections, and provides valuable information to help practitioners and parents make a more informed decision.”