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A randomised controlled trial comparing transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation with facemask pre-oxygenation in patients undergoing rapid sequence induction of anaesthesia

A randomised controlled trial comparing transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation with facemask pre-oxygenation in patients undergoing rapid sequence induction of anaesthesia
A randomised controlled trial comparing transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation with facemask pre-oxygenation in patients undergoing rapid sequence induction of anaesthesia

Pre-oxygenation is an essential part of rapid sequence induction of general anaesthesia for emergency surgery, in order to increase the oxygen reservoir in the lungs. We performed a randomised controlled trial of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation or facemask pre-oxygenation in patients undergoing emergency surgery. Twenty patients were allocated to each group. No patient developed arterial oxygen saturation < 90% during attempted tracheal intubation. Arterial blood gases were sampled from an arterial catheter immediately after intubation. The mean (SD) PaO2 was 43.7 (15.2) kPa in the THRIVE group vs. 41.9 (16.2) kPa in the facemask group (p = 0.722); PaCO2 was 5.8 (1.1) kPa in the THRIVE group vs. 5.6 (1.0) kPa in the facemask group (p = 0.631); arterial pH was 7.36 (0.05) in the THRIVE group vs. 7.34 (0.06) in the facemask group (p = 0.447). No airway rescue manoeuvres were needed, and there were no differences in the number of laryngoscopy attempts between the groups. In spite of this, patients in the THRIVE group had a significantly longer apnoea time of 248 (71) s compared with 123 (55) s in the facemask group (p < 0.001). Transnasal humidified rapid insufflation ventilatory exchange is a practicable method for pre-oxygenating patients during rapid sequence induction of general anaesthesia for emergency surgery; we found that it maintained an equivalent blood gas profile to facemask pre-oxygenation, in spite of a significantly longer apnoea time.

oxygen transport: quantitative aspects, tissue oxygen delivery: factors impacting
0003-2409
439-443
Mir, F.
a27c4d98-f611-407c-8893-44944453b8ef
Patel, A.
05f1956d-b07c-45f0-9283-3e461d8a12fa
Iqbal, R.
2744f938-f729-4043-95be-cb9718f83220
Cecconi, M.
1ccfd3b7-4b02-4935-8d37-90bdc1740c0e
Nouraei, S. A.R.
f09047ee-ed51-495d-a257-11837e74c2b3
Mir, F.
a27c4d98-f611-407c-8893-44944453b8ef
Patel, A.
05f1956d-b07c-45f0-9283-3e461d8a12fa
Iqbal, R.
2744f938-f729-4043-95be-cb9718f83220
Cecconi, M.
1ccfd3b7-4b02-4935-8d37-90bdc1740c0e
Nouraei, S. A.R.
f09047ee-ed51-495d-a257-11837e74c2b3

Mir, F., Patel, A., Iqbal, R., Cecconi, M. and Nouraei, S. A.R. (2017) A randomised controlled trial comparing transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation with facemask pre-oxygenation in patients undergoing rapid sequence induction of anaesthesia. Anaesthesia, 72 (4), 439-443. (doi:10.1111/anae.13799).

Record type: Article

Abstract

Pre-oxygenation is an essential part of rapid sequence induction of general anaesthesia for emergency surgery, in order to increase the oxygen reservoir in the lungs. We performed a randomised controlled trial of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation or facemask pre-oxygenation in patients undergoing emergency surgery. Twenty patients were allocated to each group. No patient developed arterial oxygen saturation < 90% during attempted tracheal intubation. Arterial blood gases were sampled from an arterial catheter immediately after intubation. The mean (SD) PaO2 was 43.7 (15.2) kPa in the THRIVE group vs. 41.9 (16.2) kPa in the facemask group (p = 0.722); PaCO2 was 5.8 (1.1) kPa in the THRIVE group vs. 5.6 (1.0) kPa in the facemask group (p = 0.631); arterial pH was 7.36 (0.05) in the THRIVE group vs. 7.34 (0.06) in the facemask group (p = 0.447). No airway rescue manoeuvres were needed, and there were no differences in the number of laryngoscopy attempts between the groups. In spite of this, patients in the THRIVE group had a significantly longer apnoea time of 248 (71) s compared with 123 (55) s in the facemask group (p < 0.001). Transnasal humidified rapid insufflation ventilatory exchange is a practicable method for pre-oxygenating patients during rapid sequence induction of general anaesthesia for emergency surgery; we found that it maintained an equivalent blood gas profile to facemask pre-oxygenation, in spite of a significantly longer apnoea time.

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More information

Accepted/In Press date: 29 November 2016
e-pub ahead of print date: 30 December 2016
Published date: 1 April 2017
Keywords: oxygen transport: quantitative aspects, tissue oxygen delivery: factors impacting

Identifiers

Local EPrints ID: 439645
URI: http://eprints.soton.ac.uk/id/eprint/439645
ISSN: 0003-2409
PURE UUID: 5268df54-dbd5-443e-b8f2-e1682e60e3fa

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Date deposited: 29 Apr 2020 16:30
Last modified: 16 Mar 2024 07:38

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Contributors

Author: F. Mir
Author: A. Patel
Author: R. Iqbal
Author: M. Cecconi
Author: S. A.R. Nouraei

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