Prediction of intraoperative critical events in children under mechanical ventilation: a prospective observational study

Trembach I.A.; Trembach N.V.; Zabolotskikh I.B.

doi:https://doi.org/10.17116/anaesthesiology202603143

Trembach I.A.

Children’s Regional Clinical Hospital, Krasnodar, Russia;
Kuban State Medical University, Krasnodar, Russia

ORCID: 0000-0001-7879-4793

Trembach N.V.

Kuban State Medical University, Krasnodar, Russia;
Regional Clinical Hospital No. 2, Krasnodar, Russia

ORCID: 0000-0002-0061-0496

Zabolotskikh I.B.

Kuban State Medical University, Krasnodar, Russia;
Krasnodar Regional Clinical Hospital No. 2, Krasnodar, Russia;
Federal Research Clinical Center of Intensive Care and Rehabilitology, Moscow, Russia

SPIN RSCI: 5142-1661
Scopus AuthorID: 6508104506
ResearcherID: O-2705-2014
ORCID: 0000-0002-3623-2546

Prediction of intraoperative critical events in children under mechanical ventilation: a prospective observational study

Authors:

Trembach I.A., Trembach N.V., Zabolotskikh I.B.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2026;(3): 43‑49

DOI: 10.17116/anaesthesiology202603143

Read: 277 times

Contact the author

Table of contents

To cite this article:

Trembach IA, Trembach NV, Zabolotskikh IB. Prediction of intraoperative critical events in children under mechanical ventilation: a prospective observational study. Russian Journal of Anesthesiology and Reanimatology. 2026;(3):43‑49. (In Russ.)
https://doi.org/10.17116/anaesthesiology202603143

Использование инфографики авторами научных работ

INTRODUCTION

Anesthetic safety in children remains one of the key challenges of modern clinical practice. Despite advances in monitoring and procedural standardization, the risk of intraoperative critical incidents (CI) in children remains significantly higher than in adults. Simple non-invasive tools for preoperative risk assessment based on key physiological parameters require validation.

OBJECTIVE

To analyze breath-holding test (BHT) after deep inspiration as a predictor of intraoperative CI in children undergoing mechanical ventilation (MV).

MATERIAL AND METHODS

A prospective study enrolled 135 children aged 5—10 years scheduled for elective abdominal surgery under general anesthesia with MV. Preoperative triple BHT was administered, and mean value used for analysis. Recording intraoperative CIs was the primary objective of intraoperative monitoring. Predictive value of BHT for CIs was assessed using ROC curves.

RESULTS

Intraoperative CIs were identified in 20.7% of patients. Shorter BHT after deep inspiration was significantly associated with higher incidence of intraoperative CI. AUC was 0.847 for overall critical incidents, 0.903 for hemodynamic, and 0.853 for respiratory events (p<0.001). Optimal cutoff values for BHT were ≤28 seconds for overall and hemodynamic incidents and ≤27 seconds for respiratory incidents.

CONCLUSION

BHT after deep inspiration is a simple, noninvasive, and informative method for preoperative risk stratification and demonstrates high predictive value for intraoperative CI in mechanically ventilated pediatric patients.

Keywords:

anesthesiology

child

prognosis

medical errors

breath holding

medical errors

Authors:

Trembach I.A.

Children’s Regional Clinical Hospital, Krasnodar, Russia;
Kuban State Medical University, Krasnodar, Russia

ORCID: 0000-0001-7879-4793

Trembach N.V.

Kuban State Medical University, Krasnodar, Russia;
Regional Clinical Hospital No. 2, Krasnodar, Russia

ORCID: 0000-0002-0061-0496

Zabolotskikh I.B.

Kuban State Medical University, Krasnodar, Russia;
Krasnodar Regional Clinical Hospital No. 2, Krasnodar, Russia;
Federal Research Clinical Center of Intensive Care and Rehabilitology, Moscow, Russia

SPIN RSCI: 5142-1661
Scopus AuthorID: 6508104506
ResearcherID: O-2705-2014
ORCID: 0000-0002-3623-2546

Received:

11.02.2026

Accepted:

07.04.2026

Close metadata

References:

Khoso N, Ghaffar WB, Abassi S, Khan FA. Pediatric Anesthesia Severe Adverse Events Leading to Anesthetic Morbidity and Mortality in a Tertiary Care Center in a Low- and Middle-Income Country: A 25-Year Audit. Anesthesia and Analgesia. 2021;132(1):217-222. https://doi.org/10.1213/ANE.0000000000005162
Ramgolam A, Hall GL, Zhang G, Hegarty M, von Ungern-Sternberg BS. Inhalational versus Intravenous Induction of Anesthesia in Children with a High Risk of Perioperative Respiratory Adverse Events: A Randomized Controlled Trial. Anesthesiology. 2018;128(6):1065-1074. https://doi.org/10.1097/ALN.0000000000002152
Porter LL, Blaauwendraad SM, Pieters BM. Respiratory and hemodynamic perioperative adverse events in intravenous versus inhalational induction in pediatric anesthesia: A systematic review and meta-analysis. Pediatric Anesthesia. 2020;30(8):859-866. https://doi.org/10.1111/pan.13904
Walker BJ, Long JB, Sathyamoorthy M, Birstler J, Wolf C, Bosenberg AT, Flack SH, Krane EJ, Sethna NF, Suresh S, Taenzer AH, Polaner DM, Martin L, Anderson C, Sunder R, Adams T, Martin L, Pankovich M, Sawardekar A, Birmingham P, Marcelino R, Ramarmurthi RJ, Szmuk P, Ungar GK, Lozano S, Boretsky K, Jain R, Matuszczak M, Petersen TR, Dillow J, Power R, Nguyen K, Lee BH, Chan L, Pineda J, Hutchins J, Mendoza K, Spisak K, Shah A, DelPizzo K, Dong N, Yalamanchili V, Venable C, Williams CA, Chaudahari R, Ohkawa S, Usljebrka H, Bhalla T, Vanzillotta PP, Apiliogullari S, Franklin AD, Ando A, Pestieau SR, Wright C, Rosenbloom J, Anderson T; Pediatric Regional Anesthesia Network Investigators. Complications in Pediatric Regional Anesthesia: An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network. Anesthesiology. 2018;129(4):721-732. https://doi.org/10.1097/ALN.0000000000002372
Tariq S, Syed M, Martin T, Zhang X, Schmitz M. Rates of Perioperative Respiratory Adverse Events Among Caucasian and African American Children Undergoing General Anesthesia. Anesthesia and Analgesia. 2018;127(1):181-187. https://doi.org/10.1213/ANE.0000000000003430
Park JB, Sohn JY, Kang P, Ji SH, Kim EH, Lee JH, Kim JT, Kim HS, Jang YE. Perioperative Respiratory-Adverse Events Following General Anesthesia Among Pediatric Patients After COVID-19. Journal of Korean Medical Science. 2023;38(47):e349. https://doi.org/10.3346/jkms.2023.38.e349
Lebedinskii KM, Belikov VL, Guzovskiy EI. Anesthesia related death: causes and risk factors. A narrative review. Annals of Critical Care. 2024;(3):85-95. (In Russ.). https://doi.org/10.21320/1818-474X-2024-3-85-95
von Ungern-Sternberg BS, Ramgolam A, Hall GL, Sly PD, Habre W. Peri-operative adverse respiratory events in children. Anaesthesia. 2015; 70(4):440-444. https://doi.org/10.1111/anae.12946
Khatiwada S, Bhattarai B, Pokharel K, Subedi A. Adverse Events in Children Receiving General Anaesthesia with Laryngeal Mask Airway Insertion. JNMA: Journal of Nepal Medical Association. 2015;53(198):77-82.
Tamire T, Garbessa B, Gebeyehu G, Getachew L. Tracheal Intubation-related adverse events in pediatrics anesthesia in Ethiopia. Pediatric Anesthesia. 2021;31(5):515-521. https://doi.org/10.1111/pan.14143
Trembach IA. Duration of breath-holding test after deep inspiration in predicting intraoperative critical incidents in children: a prospective observational study. Annals of Critical Care. 2025; 3:80-90. (In Russ.). https://doi.org/10.21320/1818-474X-2025-3-80-90
Brockel MA, Polaner DM, Vemulakonda VM. Anesthesia in the Pediatric Patient. Urologic Clinics of North America. 2018;45(4):551-560. https://doi.org/10.1016/j.ucl.2018.06.003
Ramaniuk TI, Pozdnyakov DYu, Mushenok FB. Artificial intelligence and machine learning in intensive care unit. Russian Journal of Anesthesiology and Reanimatology. 2021;(4):97-104. (In Russ.). https://doi.org/10.17116/anaesthesiology202104197
Bartels DD, McCann ME, Davidson AJ, Polaner DM, Whitlock EL, Bateman BT. Estimating pediatric general anesthesia exposure: Quantifying duration and risk. Pediatric Anesthesia. 2018;28(6):520-527. https://doi.org/10.1111/pan.13391
Sun M, Chen WM, Fu S, Wu SY, Zhang J. Early childhood general anesthesia and risk of Attention Deficit Hyperactivity Disorder. Journal of Child Psychology and Psychiatry, and Allied Disciplines. 2024;65(2):165-175. https://doi.org/10.1111/jcpp.13871
Lerman J. Pediatric ambulatory anesthesia: an update. Current Opinion in Anaesthesiology. 2019;32(6):708-713. https://doi.org/10.1097/ACO.0000000000000787
McLeod DJ, Asti L, Mahida JB, Deans KJ, Minneci PC. Preoperative risk assessment in children undergoing major urologic surgery. Journal of Pediatric Urology. 2016;12(1):26.e1-26.e267. https://doi.org/10.1016/j.jpurol.2015.04.044
Brown RE Jr. Safety considerations of anesthetic drugs in children. Expert Opinion on Drug Safety. 2017;16(4):445-454. https://doi.org/10.1080/14740338.2017.1295037
Lewanda AF, Matisoff A, Revenis M, Harahsheh A, Futterman C, Nino G, Greenberg J, Myseros JS, Rosenbaum KN, Summar M. Preoperative evaluation and comprehensive risk assessment for children with Down syndrome. Pediatric Anesthesia. 2016;26(4):356-362. https://doi.org/10.1111/pan.12841
Sokolov DA, Zhbannikov PS, Ganert AN, Larionov SV, Lyuboshevskiy PA. Accuracy of predictors of perioperative cardiovascular complications in onco-surgery. Russian Journal of Anesthesiology and Reanimatology. 2023;(3): 37-44. (In Russ.). https://doi.org/10.17116/anaesthesiology202303137
Spasskaya AA, Govorova NV, Orlov YuP, Nesterova KI, Goltyapin VV. Factor analysis of perioperative complications in anesthetic support of surgeries for cicatricial tracheal stenosis. Russian Journal of Anesthesiology and Reanimatology. 2025;(6):8-14. (In Russ.). https://doi.org/10.17116/anaesthesiology20250618