Comparison of arterial oxygenation and acid-base balance with the use of transnasal humidified rapid-insufflation ventilatory exchange versus tidal volume breathing with continuous positive airway pressure for preoxygenation and apneic ventilation

Abstract

Background:Preoxygenation and apneic ventilation prolong apnea time without desaturation.Aims:The primary objective of this study is to compare arterial oxygenation during the periods of apnea following preoxygenation and apneic ventilation with tidal volume breathing for 3 min with continuous positive airway pressure (CPAP) versus with transnasal humidified rapid-insufflation ventilatory exchange (THRIVE).Settings and Designs:This prospective randomized study was conducted in 20 adult patients at a tertiary care institution.Subjects and Methods:Group C patients (n = 10) were preoxygenated with 100% oxygen using a face mask at a rate of 6 L/min for 3 min with CPAP of 15 cm of H2O. In Group H, oxygen was administered using THRIVE at 30 L/min for 3 min. Apneic ventilation was given in Group C with 10 L/min oxygen with CPAP of 15 cm H2O and in Group H with THRIVE at 60 L/min. The endpoint was desaturation to 90% or maximum duration of 12 min.Statistical Analysis Used:Chi-square test and Mann–Whitney test.Results:Both groups tolerated apnea for 12 min without desaturation. PaO2 in Group C was significantly higher than Group H from 3 min of apnea to 12 min. The PaCO2 was significantly lower in Group C from 6 min. The pH was comparable in both groups except at 12 min with Group H having significantly lower pH.Conclusion:Tidal volume breathing with CPAP resulted in significantly higher arterial oxygen levels than THRIVE, though both modalities were equally effective in prolonging apnea time without desaturation up to 12 min. Group C showed an added advantage of lower PaCO2 with less acidemia.

Preoxygenation with standard facemask combining apnoeic oxygenation using high flow nasal cannula versuss standard facemask alone in patients with and without obesity: the OPTIMASK international study

“…HFNO produced a higher PaO2 after pre-oxygenation and safe PaO2 during intubation. Another preliminary study [ 22 ] found similar results. No previous study has simultaneously assessed facemask and HFNO for optimizing both preoxygenation and apnoeic oxygenation in a large multinational study.…”

Recent advances in anesthesia of the obese patient

“…Both treatments were equally effective in prolonging SAP without desaturation for up to 12 minutes. The CPAP group had an added advantage of lower PaCO 2 with less acidosis 5 . The use of high-flow nasal O 2 during pre-oxygenation and then continued during apnea can also prevent hypoxia before and during intubation attempts by extending SAP 6 .…”