Abstract:
Here’s a balanced debate on the routine use of supplemental oxygen during pediatric procedural sedation (PPS), based on current evidence and pediatric emergency medicine standards:
YES:
Support for Routine Use of Supplemental Oxygen
1.Prevention of Hypoxia
- Respiratory depression is a common risk during PPS, especially with sedatives like opioids or benzodiazepines.
- Routine supplemental oxygen provides a buffer, delaying oxygen desaturation in case of hypoventilation or apnea .
2. Increased Safety Margin
- Particularly helpful in:
- Children with underlying respiratory compromise.
- Deep sedation or prolonged procedures.
- Oxygen can buy time for clinicians to recognize and intervene before critical hypoxia develops.
3. Guidelines Support It in Many Situations
- Several procedural sedation protocols (e.g., with ketamine or propofol) recommend pre-oxygenation or oxygen supplementation, particularly when advanced airway skills may not be immediately available .
NO:
Against Routine Use of Supplemental Oxygen
1. May Delay Recognition of Hypoventilation
- Pulse oximetry can remain falsely reassuring if supplemental oxygen is given, masking early signs of hypoventilation.
- This may delay detection of respiratory compromise until it becomes severe (e.g., hypercapnia).
2. Not All Sedation Requires It
- In minimal to moderate sedation, with intact airway reflexes and spontaneous ventilation, routine oxygen is unnecessary and could expose children to unnecessary intervention or monitoring.
- Overuse also increases costs and equipment burden.
3. Capnography is Preferable
- Capnography (ETCO? monitoring) is more sensitive in detecting early hypoventilation.
- Using capnography instead of relying on oxygen saturation can improve safety without the routine need for oxygen .
Conclusion
Routine supplemental oxygen is beneficial in higher-risk sedations but may not be justified for all pediatric cases. The decision should be individualized based on:
- Sedation depth,
- Patient comorbidities,
- Procedure type,
- Availability of capnography.
A selective approach, emphasizing clinical judgment, capnography monitoring, and patient-specific risk assessment, is supported by leading pediatric emergency guidelines .
