Delayed Sequence Intubation in Children, Why Not?

Abstract

Tracheal intubation in pediatric patients is a clinical scenario that can quickly become an emergency. Complication rates can potentially reach up to 60% in rapid sequence intubation. An alternate to this is delayed sequence intubation, which may reduce potential complications—mostly hypoxemia—and can be especially useful in non-cooperative children. This technique consists of the prior airway and oxygenation optimization. This is done through sedation using agents that preserve ventilatory function and protective reflexes and continuous oxygen therapy—prior and after the anesthetic induction—using nasal prongs. The objective of this narrative review is to provide a broader perspective on delayed sequence intubation by defining the concept and indications; reviewing its safety, effectiveness, and complications; and describing the anesthetic agents and oxygen therapy techniques used in this procedure.

Keywords

• airway management; apneic oxygenation; child; delayed sequence intubation; pediatric anesthesia; pediatric critical care; rapid sequence intubation; sedation