Upper Respiratory Infections and Respiratory Adverse Events and Interventions in Emergency Department Sedation of Children.

Children with upper respiratory infections (URIs) undergoing sedation in emergency departments (EDs) do not face a higher risk of respiratory complications or need for serious interventions compared to those without URIs. A secondary analysis of 6,292 children aged 17 years or younger who received parenteral sedation in six pediatric EDs found that the adjusted odds of any respiratory adverse event, serious adverse event, or serious intervention (such as bag-valve-mask ventilation or intubation) were not significantly elevated. The odds ratios were 1.00, 0.53, and 1.08, respectively, with confidence intervals crossing 1.0, indicating no detectable increase in risk.

Study at a glance

Abstract

Children with upper respiratory infections (URIs) have an increased risk of respiratory adverse events when undergoing operative anesthesia and in general populations of children receiving procedural sedation. It is unclear if children with URI undergoing emergency department (ED) sedation share the same increased risk. We aimed to determine if the presence of a URI in children undergoing ED sedation is associated with increased risk of respiratory adverse events and serious respiratory interventions. We conducted a secondary analysis of a prospective cohort study of children aged 17 years or younger who received parenteral sedation for a painful procedure in 1 of 6 pediatric EDs. A multivariable regression model was used to identify potential associations between URI and respiratory adverse events, serious respiratory adverse events (ie, complete airway obstruction, apnea, laryngospasm, clinically apparent pulmonary aspiration, and death), and serious respiratory interventions (ie, bag-valve-mask ventilation and endotracheal intubation). We analyzed 6,292 children; 444 (7.1%) had a URI. The risk of respiratory adverse events, serious respiratory adverse events, or serious respiratory interventions was adjusted odds ratio (aOR) 1.00 (95% confidence interval [CI] 0.78 to 1.29), 0.53 (95% CI 0.18 to 1.58), and 1.08 (95% CI 0.68 to 1.71), respectively. In this study, we found no increase in risk of any respiratory adverse events or serious respiratory interventions associated with URI in children undergoing ED sedation.