Transnasal humidified rapid insufflation ventilatory exchange for oxygenation of children during apnoea: a prospective randomised controlled trial

Abstract

NCT02979067.

Uses and mechanisms of apnoeic oxygenation: a narrative review

“…Randomised controlled trials have shown a delayed time to oxygen desaturation with use of pharyngeal oxygen insufflation during elective traxcheal intubation . In one study, apnoeic oxygenation with high‐flow nasal oxygen at 1–2 l.kg.min −1 reduced the incidence of desaturation during intubation when compared with a control arm that did not receive any supplemental oxygen during apnoea . Another trial compared use of low‐flow nasal oxygen at 0.2 l.kg.min −1 (F I O 2 1.0), high‐flow nasal oxygen at 2 l.kg.min −1 (F I O 2 1.0), and high‐flow nasal oxygen 2 l.kg.min −1 (F I O 2 0.3) at induction of anaesthesia .…”

“…In the presence of upper airway soiling from bleeding or regurgitation, pharyngeal contents can be dispersed with high‐flow oxygen insufflation, and a case of aspiration of gastric contents has been reported . However, gastric insufflation has not been observed using ultrasonographic and computed tomographic assessment of gastric volumes . Apnoeic oxygenation can be advantageous when incorporated into RSI techniques in circumstances where positive pressure ventilation before intubation could confer particular harm, such as the patient with tracheo‐oesophageal fistula or pyloric stenosis .…”

Emerging trends, techniques, and equipment for airway management in pediatric patients

“…Passive oxygenation or apneic oxygenation has long been known to increase safe apnea time in both children and adults . A small randomized controlled trial of healthy children age 1‐8 years undergoing elective surgery demonstrated that children receiving 3 liters per minute (LPM) O 2 via nasal cannula during airway management had higher oxygen saturation compared with children assigned to standard of care .…”

“…Randomized trials in pediatric patients have shown that deep pharyngeal or laryngeal insufflation of oxygen via a laryngoscope results in slower rate of oxygen desaturation during laryngoscopy and extends apneic time before the onset of hypoxemia . In addition to the above techniques, the use of high flow, humidified oxygen via nasal cannula, as well as via simple nasal cannula at rates as low as 0.2 L/kg/min, has been shown to extend safe apneic times in pediatric patients and is reviewed by Humphreys and Schibler elsewhere in this issue.…”

Carbon dioxide clearance during apnoea with high‐flow nasal oxygen: epiphenomenon or a failure to THRIVE?

“…This confirmed an oxygenation benefit in morbidly obese patients, extending the safe apnoea time from 180 to 261 s, but reported no difference in plateau end‐tidal carbon dioxide at the end of apnoea (5.11 kPa vs. 4.99 kPa). The only two randomised trials of high‐flow nasal oxygen with arterial or transcutaneous carbon dioxide measurements have been conducted in paediatric populations . Humphreys et al.…”