Oxygen Supplementation in Pediatric Sedation: Prospective, Multicenter, Randomized Controlled Trial.

Summary

In a multicenter RCT of 250 children undergoing moderate-to-deep sedation, both low-flow nasal cannula and high-flow nasal cannula drastically reduced hypoxemia versus no oxygen, with fewer rescue interventions and complications. High-flow was not significantly superior to low-flow, supporting low-flow oxygen as a pragmatic standard.

Key Findings

• Hypoxemia incidence: control 27.6% vs low-flow 7.2% vs high-flow 1.2% (P<0.001).
• Odds of hypoxemia vs control: low-flow OR 0.184 (95% CI 0.067–0.503); high-flow OR 0.026 (95% CI 0.003–0.207).
• Rescue interventions: control 52.9% vs low-flow 10.8% vs high-flow 3.6% (P<0.001).
• High-flow was not statistically superior to low-flow (OR 0.143; 95% CI 0.017–1.245; P=0.078).

Clinical Implications

Adopt routine low-flow oxygen supplementation during moderate-to-deep pediatric sedation to prevent hypoxemia and reduce rescue interventions; reserve high-flow for selected higher-risk cases or when low-flow is insufficient.

Limitations

• High-flow vs low-flow comparison may be underpowered for detecting small differences.
• Generalisability may be influenced by sedation protocols and monitoring practices at participating centers.

Future Directions

Define risk strata to target high-flow nasal cannula; assess cost-effectiveness and implementation outcomes across diverse procedural settings.