Reply to ‘Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a randomized controlled trial’

McCormack, James G.; Krosnar, S.; Baxter, Alistair

doi:10.1093/bja/aex160

Cited by 6 publications

(4 citation statements)

References 3 publications

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“…Should such a practice develop in paediatric anaesthesia, respiratory acidosis would become a limiting factor for use in the setting of adequate oxygenation. However, high‐flow nasal oxygen is increasingly used in conjunction with spontaneous respiration in the paediatric population [48]. This enables dynamic airway assessment by the surgeon and overcomes the significant uncertainty that infants and children would reliably tolerate apnoea for the duration of the procedure.…”

Section: Apnoeic Ventilationmentioning

confidence: 99%

Apnoeic oxygenation in paediatric anaesthesia: a narrative review

Lyons

Callaghan

2020

Anaesthesia

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Apnoeic oxygenation refers to oxygenation in the absence of any patient or ventilator effort to move the lungs. This phenomenon was first described in humans in the mid-20th century but has seen renewed interest in the last decade following the demonstration of apnoeic oxygenation with low-flow, and subsequently high-flow, nasal oxygen. This narrative review summarises our understanding of apnoeic oxygenation in the paediatric population. We examine the evidence supporting oxygenation via tracheal tube, modified laryngoscopes and nasal cannulae. The evidence for prolongation of safe apnoea time at induction of anaesthesia is also appraised. We explore the capacity for carbon dioxide clearance, flow rate selection with high-flow nasal oxygen and complications associated with the technique. It remains uncertain whether apnoeic oxygenation in paediatric patients results in a meaningful clinical benefit compared with standard care for outcomes such as the number of tracheal intubation attempts or the incidence of hypoxaemia. In particular, the role of apnoeic oxygenation in paediatric difficult airway management is unclear as this has not been the targeted focus of any published research to date.

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Section: Apnoeic Ventilationmentioning

confidence: 99%

Apnoeic oxygenation in paediatric anaesthesia: a narrative review

Lyons

Callaghan

2020

Anaesthesia

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“…HFNO may also be used in children, including in premature babies, who are undergoing airway surgeries. For example, a report describes the successful use of HFNO (at the flow rate of 2 L/kg/min) in more than 30 children (aged 6 days to 13 years) undergoing airway surgeries (e.g., aryepiglottoplasty, subglottic cyst excisions, tracheal dilatations, and endoscopic cricoid splints) [74]. The FiO 2 was titrated to maintain the SpO 2 at 95–99%, and spontaneous breathing was successfully preserved during surgery.…”

Section: Hfno During the Induction Of Anesthesiamentioning

confidence: 99%

“…HFNO may be used both in patients who are apneic [59,68,71–73,75,78,79] and in those who are breathing spontaneously [44,70,74,76,77]. The preservation of spontaneous breathing may permit a better control on the increase in carbon dioxide, airway patency, and oxygenation [44].…”

Section: Hfno During the Induction Of Anesthesiamentioning

confidence: 99%

“…To maintain spontaneous breathing, adequate titration of the sedative or anesthetic agents to maintain deep sedation and adequate topicalization of the upper airway are required; this makes sure that the patient can tolerate a surgery in the airway [70,74,76]. One method is to perform laryngoscopy and to spray a local anesthetic in the airway before performing the airway surgery [70].…”

Section: Hfno During the Induction Of Anesthesiamentioning

confidence: 99%

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High-flow nasal oxygenation for anesthetic management

Kim

2019

Korean J Anesthesiol

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High-flow nasal oxygenation (HFNO) is a promising new technique for anesthesiologists. The use of HFNO during the induction of anesthesia and during upper airway surgeries has been initiated, and its applications have been rapidly growing ever since. The advantages of this technique include its easy set-up, high tolerability, and its abilities to produce positive airway pressure and a high fraction of inspired oxygen and to influence the clearance of carbon dioxide to some extent. HFNO, via a nasal cannula, can provide oxygen both to patients who can breathe spontaneously and to those who are apneic; further, this technique does not interfere with bag-mask ventilation, attempts at laryngoscopy for tracheal intubation, and surgical procedures conducted in the airway. In this review, we describe the techniques associated with HFNO and the advantages and disadvantages of HFNO based on the current state of knowledge.

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