| Affiliation: | 1. Department of Anaesthesiology & Pain Therapy, Bern University Hospital, Inselspital, Freiburgstrasse 8, 3010 Bern, Switzerland;2. Department of Anaesthesia, Evelina London Children''s Hospital, Guy''s and St. Thomas'' NHS Foundation Trust, London, UK |
| Abstract: | BackgroundTransnasal 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.MethodsSixty 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.ResultsThe 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).ConclusionsHigh-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. |
