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Deliberate Oxygen Deprivation in Children

1995; Lippincott Williams & Wilkins; Volume: 80; Issue: 6 Linguagem: Inglês

10.1213/00000539-199506000-00033

1526-7598

Chuck Biddle, Allen J. Hinkle,

Airway Management and Intubation Techniques

To the Editor: We read with interest, concern, and utter perplexity the letter by Dupeyrat et al. [1] regarding preoxygenation in children. Here they report that they induced a period of apnea in 67 anesthetized and paralyzed children aged 2 mo to 10 yr who had their endotracheal tubes disconnected from ventilatory apparatus and left to room air. In some cases the hemoglobin saturation decreased to 79%. We would like the authors of the letter to respond to the following concerns: 1. No mention of informed consent was supplied. Furthermore, assuming it was obtained, can parents give informed consent to their children undergoing dangerous manipulations where the child stands no chance of benefitting from the manipulation? Because children are rarely able to give informed consent, research involving children is morally right only if it is the best means to effect the child's recovery from illness or disease, or if it is used to protect the child from some greater risk [2]. While acknowledging that parents can give proxy consent to nonbeneficial, nontherapeutic pediatric research when the risks are minimal and the benefits to children as a group are great [3], we feel that neither of these attributes characterizes the letter. 2. What is the purpose of performing experiments which demonstrate that apneic infants and children desaturate to dangerous levels? That children at their FRC desaturate rapidly in the face of apnea has been known for many decades. Furthermore, admonishing that "when the SpO2 value is <94%, oxygen must be administered before intubation can be performed" was not the question initially posited, was not studied appropriately, and does not effectively address the wide range of clinical presentations which one sees in the daily care of patients. 3. What are the role and purpose of reporting "studies" in the form of a letter? If the purpose is to advance scientific understanding, it falls short of the mark given the absence of sufficient methodologic and interpretive information provided. 4. Is it appropriate for a prominent American anesthesia journal to report "studies" from other countries which probably could not be performed in the United States owing to the underlying ethical issues? Readers have learned from Dupeyrat et al. [1] that young children desaturate very quickly and continue to do so even after corrective action is begun. We believe that we knew this already and further feel that their philosophical and methodologic approach to the issue was inappropriate. We further question the decision of the editor to publish this "study." Chuck Biddle, PhD, CRNA Allen Hinkle, MD Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756