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

Background Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) comprises the administration of heated, humidified, and blended air/oxygen mixtures via nasal cannula at rates of ≥2 litres kg−1 min−1. The aim of this randomized controlled study was to evaluate the length of the safe apnoea time using THRIVE with two different oxygen concentrations (100% vs 30% oxygen) compared with standard low-flow 100% oxygen administration. Methods Sixty patients, aged 1–6 yr, weighing 10–20 kg, undergoing general anaesthesia for elective surgery, were randomly allocated to receive one of the following oxygen administration methods during apnoea: 1) low-flow 100% oxygen at 0.2 litres kg−1 min−1; 2) THRIVE 100% oxygen at 2 litres kg−1 min−1; and 3) THRIVE 30% oxygen at 2 litres kg−1 min−1. Primary outcome was time to desaturation to 95%. Termination criteria included SpO2 decreased to 95%, transcutaneous CO2 increased to 65 mmHg, or apnoea time of 10 min. Results The median (interquartile range) [range] apnoea time was 6.9 (5.7–7.8) [2.8–10.0] min for low-flow 100% oxygen, 7.6 (6.2–9.1) [5.2–10.0] min for THRIVE 100% oxygen, and 3.0 (2.4–3.7) [0.2–5.3] min for THRIVE 30% oxygen. No significant difference was detected between apnoea times with low-flow and THRIVE 100% oxygen administration (P=0.15). THRIVE with 30% oxygen demonstrated significantly shorter apnoea times (P Conclusions High-flow 100% oxygen (2 litres kg−1 min−1) administered via nasal cannulas did not extend the safe apnoea time for children weighing 10–20 kg compared with low-flow nasal cannula oxygen (0.2 litres kg−1 min−1). No ventilatory effect was observed with THRIVE at 2.0 litres kg−1 min−1. Clinical trial registration NCT02979067.