THRIVE: five years on and into the COVID-19 era

Sud, Anika; Patel, Anil

doi:10.1016/j.bja.2020.12.030

Cited by 12 publications

(9 citation statements)

References 34 publications

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“…This challenges the notion that HFNO delivery improves efficiency of ventilatory exchange 10,28 and, correspondingly, that enhanced carbon dioxide clearance is responsible for any increase in efficiency of apnoeic oxygenation when high gas flows are used. 29 It has been hypothesised that apnoeic carbon dioxide clearance may become more efficient as alveolar concentration increases. 9 We did not observe a 'plateau' where Pa CO2 stopped increasing.…”

Section: Apnoeic Ventilationmentioning

confidence: 99%

Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery

Schutzer-Weissmann¹,

Wojcikiewicz²,

Karmali³

et al. 2023

British Journal of Anaesthesia

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Background: Obesity is a risk factor for airway-related incidents during anaesthesia. High-flow nasal oxygen has been advocated to improve safety in high-risk groups, but its effectiveness in the obese population is uncertain. This study compared the effect of high-flow nasal oxygen and low-flow facemask oxygen delivery on duration of apnoea in morbidly obese patients. Methods: Morbidly obese patients undergoing bariatric surgery were randomly allocated to receive either high-flow nasal (70 L min À1 ) or facemask (15 L min À1 ) oxygen. After induction of anaesthesia, the patients were apnoeic for 18 min or until peripheral oxygen saturation decreased to 92%. Results: Eighty patients were studied (41 High-Flow Nasal Oxygen, 39 Facemask). The median apnoea time was 18 min in both the High-Flow Nasal Oxygen (IQR 18e18 min) and the Facemask (inter-quartile range [IQR], 4.1e18 min) groups. Five patients in the High-Flow Nasal Oxygen group and 14 patients in the Facemask group desaturated to 92% within 18 min. The risk of desaturation was significantly lower in the High-Flow Nasal Oxygen group (hazard ratio¼0.27; 95% confidence interval [CI], 0.11e0.65; P¼0.007). Conclusions: In experienced hands, apnoeic oxygenation is possible in morbidly obese patients, and oxygen desaturation did not occur for 18 min in the majority of patients, whether oxygen delivery was high-flow nasal or low-flow facemask. High-flow nasal oxygen may reduce desaturation risk compared with facemask oxygen. Desaturation risk is a more clinically relevant outcome than duration of apnoea. Individual physiological factors are likely to be the primary determinant of risk rather than method of oxygen delivery. Clinical trial registration: NCT03428256.

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Section: Apnoeic Ventilationmentioning

confidence: 99%

Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery

Schutzer-Weissmann¹,

Wojcikiewicz²,

Karmali³

et al. 2023

British Journal of Anaesthesia

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“…HFNO usage during apnea has recently been studied using the newly coined “Transnasal Humidified Rapid Insufflation Ventilatory Exchange” (THRIVE) technique, where HFNO maintains oxygenation during intubation and extends apnea time ( 83 , 84 ). HFNO administration reported an average apneic time of 17 min for difficult airways in 25 adult patients ( 85 ).…”

Section: Use Of High Flow Nasal Oxygen In Proceduresmentioning

confidence: 99%

Recent advances in the use of high flow nasal oxygen therapies

Wyatt¹,

Goel

Whittle

2022

Front. Med.

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High flow nasal oxygen is a relatively new option for treating patients with respiratory failure, which decreases work of breathing, improves tidal volume, and modestly increases positive end expiratory pressure. Despite well-described physiologic benefits, the clinical impact of high flow nasal oxygen is still under investigation. In this article, we review the most recent findings on the clinical efficacy of high flow nasal oxygen in Type I, II, III, and IV respiratory failure within adult and pediatric patients. Additionally, we discuss studies across clinical settings, including emergency departments, intensive care units, outpatient, and procedural settings.

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“…A complex set of factors ultimately determines apnoea time; some of these factors can be improved while others are less amenable to modification. These include alveolar oxygen content at the end of pre‐oxygenation (FRC × F A O 2 ); magnitude of the effect of mechanisms that will add to the oxygen reservoir during apnoea, that is apnoeic oxygenation and ventilation (via both reciprocal clearance of alveolar carbon dioxide and ‘active’ replacement of oxygen); factors affecting oxygen cascade, transport and cellular uptake; and metabolic rate of oxygen consumption [17].…”

Section: Mechanismsmentioning

confidence: 99%