Transnasal humidified rapid insufflation ventilatory exchange for oxygenation of children during apnoea: a prospective randomised controlled trial.

Abstract

Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) comprises the administration of heated, humidified, and blended air/oxygen mixtures via nasal cannula at rates of ≥2 litres kg^-1 min^-1. The aim of this randomized controlled study was to evaluate the length of the safe apnoea time using THRIVE with two different oxygen concentrations (100% vs 30% oxygen) compared with standard low-flow 100% oxygen administration. Sixty patients, aged 1-6 yr, weighing 10-20 kg, undergoing general anaesthesia for elective surgery, were randomly allocated to receive one of the following oxygen administration methods during apnoea: 1) low-flow 100% oxygen at 0.2 litres kg^-1 min^-1; 2) THRIVE 100% oxygen at 2 litres kg^-1 min^-1; and 3) THRIVE 30% oxygen at 2 litres kg^-1 min^-1. Primary outcome was time to desaturation to 95%. Termination criteria included SpO₂ decreased to 95%, transcutaneous CO₂ increased to 65 mmHg, or apnoea time of 10 min. The median (interquartile range) [range] apnoea time was 6.9 (5.7-7.8) [2.8-10.0] min for low-flow 100% oxygen, 7.6 (6.2-9.1) [5.2-10.0] min for THRIVE 100% oxygen, and 3.0 (2.4-3.7) [0.2-5.3] min for THRIVE 30% oxygen. No significant difference was detected between apnoea times with low-flow and THRIVE 100% oxygen administration (P=0.15). THRIVE with 30% oxygen demonstrated significantly shorter apnoea times (P<0.001) than both 100% oxygen modalities. The overall rate of transcutaneous CO₂ increase was 0.57 (0.49-0.63) [0.29-8.92] kPa min^-1 without differences between the 3 groups (P=0.25). High-flow 100% oxygen (2 litres kg^-1 min^-1) administered via nasal cannulas did not extend the safe apnoea time for children weighing 10-20 kg compared with low-flow nasal cannula oxygen (0.2 litres kg^-1 min^-1). No ventilatory effect was observed with THRIVE at 2.0 litres kg^-1 min^-1. NCT02979067.