Nasal high‐flow oxygen delivery in children with abnormal airways

Humphreys, Susan; Rosen, Derek; Housden, Tessa; Taylor, Julia R.; Schibler, Andreas

doi:10.1111/pan.13151

Cited by 46 publications

(48 citation statements)

References 10 publications

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“…Since the introduction of trans‐nasal humidified rapid‐insufflation ventilatory exchange (THRIVE) , there has been a rapid expansion in the peri‐operatively use of HFNO, ranging from apnoeic oxygenation (THRIVE) to procedural sedation and the management of difficult airways . The role of HFNO in paediatric anaesthesia is emerging, showing a promising role in providing apnoeic oxygenation and managing patients with abnormal airways . Paediatric patients experience haemoglobin oxygen desaturation much more rapidly than adults due to their limited functional residual capacity and high metabolic rate, and a tendency for airway collapse .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, HFNO during anaesthesia has been a focus of novel research in adults with difficult airway and has been demonstrated to prolong apnoea time without hypoxia following induction of anaesthesia and before a definitive airway can be established . However, there are few publications regarding the use of HFNO in managing children with difficult airways .…”

Section: Introductionmentioning

confidence: 99%

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The use of high‐flow nasal oxygen during airway management in a child with epidermolysis bullosa dystrophica and a difficult airway

Chan

Lam

2019

Anaesthesia Reports

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Summary The role of high‐flow nasal oxygen in paediatric anaesthesia has been emerging in recent years. However, literature regarding its benefits in paediatric difficult airway management is limited. In this case report, we describe the use of high‐flow nasal oxygen during airway management of a child with a difficult airway due to epidermolysis bullosa dystrophica in whom the use of a facemask would have been potentially harmful. Deep sedation was achieved with propofol and remifentanil while maintaining spontaneous breathing before flexible bronchoscopic tracheal intubation was attempted. However, on attempted tracheal intubation difficulty was encountered due to poor visualisation and contact bleeding. Tracheal intubation was eventually successful after converting to videolaryngoscopy. Oxygenation was maintained throughout the process despite deep sedation and a long procedure time. Moreover, no skin abrasions or mucosal injury resulted from the use of high‐flow nasal oxygen. We conclude that high‐flow nasal oxygen has a valuable role during airway management for a child with a predicted difficult airway when the use of a facemask would have been potentially harmful.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The use of high‐flow nasal oxygen during airway management in a child with epidermolysis bullosa dystrophica and a difficult airway

Chan

Lam

2019

Anaesthesia Reports

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“…THRIVE is the subject of an ongoing study regarding its applicability to emergency pediatric intubations . Even the most enthusiastic proponents of the THRIVE technique chose a gas induction in 15/20 (75%) of their case series describing its use in more challenging airway cases!…”

Section: In a Few Words: What Do You Consider The Main Current Disadvmentioning

confidence: 99%

Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro‐con discussion

Lauder

Thomas

Ungern‐Sternberg

et al. 2020

Pediatric Anesthesia

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Anesthesia for pediatric airway procedures constitutes a true art form that requires training and experience. Communication between anesthetist and surgeon to establish procedure goals is essential in determining the most appropriate anesthetic management. But does the mode of anesthesia have an impact? Traditionally, inhalational anesthesia was the most common anesthesia technique used during airway surgery. Introduction of agents used for total intravenous anesthesia (TIVA) such as propofol, short‐acting opioids, midazolam, and dexmedetomidine has driven change in practice. Ongoing debates abound as to the advantages and disadvantages of volatile‐based anesthesia versus TIVA. This pro‐con discussion examines both volatiles and TIVA, from the perspective of effectiveness, safety, cost, and environmental impact, in an endeavor to justify which technique is the best specifically for pediatric airway procedures.

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“…The choice of intravenous anesthesia agent usually includes propofol with a short‐acting potent opioid. As an example of a successful regime, Malherbe et al describe a technique of a propofol bolus 1‐5 mg/kg followed by infusion at 200‐500 mcg/kg/min with remifentanil 0.1‐0.2 mcg/kg/min . The remifentanil can be titrated in increments of 0.05 mcg/kg/min to maintain respiratory rate appropriate for the age of the child.…”

Section: Practical Aspects Of Nhf For Anesthesiamentioning

confidence: 99%

“…The first 72 hours after surgery is a period of high risk. A prospective survey of >18 000 patients in the postanesthesia care unit revealed a complication rate of 7% related to airway obstruction and therefore perhaps, maintaining NHF until awake may reduce the incidence of hypoxemia related to reduced upper airway tone . There are currently no data to support the efficacy of NHF in this environment.…”

Section: Nhf Use In Postanesthesia Care Unitmentioning

confidence: 99%

Nasal high‐flow oxygen in pediatric anesthesia and airway management

Humphreys

Schibler

2019

Pediatric Anesthesia

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Nasal High‐Flow (NHF) is weight‐dependent in children, aimed to match peak inspiratory flow and thereby deliver an accurate FiO2 with a splinting pressure of 4‐6 cm H2O. During apnea in children, NHF oxygen can double the expected time to desaturation below 90% in well children but there is no ventilatory exchange; therefore, children do not “THRIVE”. Total intravenous anesthesia competency to maintain spontaneous breathing is an important adjunct for successful NHF oxygenation technique during anesthesia. Jaw thrust to maintain a patent upper airway is paramount until surgical instrumentation occurs. There is no evidence to support safe use of NHF oxygen with LASER use due to increased risk of airway fire.

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Nasal high‐flow oxygen delivery in children with abnormal airways

Abstract: Nasal high flow can be used in spontaneously breathing children with abnormal airways for maintenance of oxygenation during anesthesia for tubeless airway procedures.

Cited by 46 publications

References 10 publications

The use of high‐flow nasal oxygen during airway management in a child with epidermolysis bullosa dystrophica and a difficult airway

The use of high‐flow nasal oxygen during airway management in a child with epidermolysis bullosa dystrophica and a difficult airway

Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro‐con discussion

Nasal high‐flow oxygen in pediatric anesthesia and airway management

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