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Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a randomized controlled trial
S Humphreys1,2, P Lee-Archer1,2, G Reyne1,3
1Paediatric Critical Care Research Group, Mater Research University of Queensland, Lady Cilento Children's Hospital, 501 Stanley Street, South Brisbane, QLD 4101, Australia.
Insights
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) significantly extends safe apnoea times in children undergoing general anaesthesia. While THRIVE improves oxygenation duration, it does not enhance carbon dioxide removal.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
- Critical Care Medicine
Background:
- Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is an airway management technique for adults.
- Its efficacy in pediatric patients requires further investigation.
- This study aimed to assess THRIVE's safety and effectiveness in children.
Purpose of the Study:
- To determine if THRIVE safely prolongs apnoeic oxygenation in children.
- To compare apnoeic times between THRIVE and standard care (jaw support).
- To evaluate the impact on transcutaneous hemoglobin and CO2 levels.
Main Methods:
- A randomized controlled trial involving 48 healthy children across various age groups.
- Children received sevoflurane, O2, N2O, rocuronium, and bag-and-mask preoxygenation.
- The THRIVE group received THRIVE with age-specific flow rates, while the control group received only jaw support.
Main Results:
- The THRIVE group demonstrated significantly longer apnoea times across all age groups compared to the control group.
- Average transcutaneous hemoglobin saturation remained high (99.6%) in the THRIVE arm.
- Transcutaneous CO2 increased similarly in both groups, indicating no significant difference in CO2 clearance.
Conclusions:
- THRIVE effectively prolongs safe apnoea time in healthy pediatric patients.
- THRIVE does not appear to improve CO2 clearance in this population.
- The technique offers a potential safety improvement for pediatric airway management during apnoea.
Background:
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) was introduced to adult anaesthesia to improve the safety of airway management during apnoea before intubation. The objective of our study was to determine whether THRIVE safely prolongs apnoeic oxygenation in children.
Methods:
This was a randomized controlled trial in 48 healthy children, with normal airways and cardiorespiratory function, in age groups 0-6 and 7-24 months, 2-5 and 6-10 yr old, presenting for elective surgery or imaging under general anaesthesia. All children were induced with sevoflurane, O2, and N2O, followed by muscle relaxation with rocuronium, and standardized preoxygenation with bag-and-mask ventilation. The control arm received jaw support during apnoea, whereas the THRIVE arm received jaw support during apnoea and age-specific flow rates. The primary outcome was to demonstrate that children allocated to THRIVE maintain transcutaneous haemoglobin saturation at least twice as long as the expected age-dependent apnoea time in the control group.
Results:
Both study arms (each n=24) were similar in age and weight. The apnoea time was significantly shorter in the control arm: average 109.2 (95% CI 28.8) s in the control arm and 192 s in the THRIVE arm (0-6 months), 147.3 (95% CI 18.9) and 237 s (7-24 months), 190.5 (95% CI 15.3) and 320 s (2-5 yr), and 260.8 (95% CI 37.5) and 430 s (6-10 yr), respectively. Average transcutaneous haemoglobin saturation remained at 99.6% (95% CI 0.2) during THRIVE. Transcutaneous CO2 increased to a similar extent in both arms, with 2.4 (95% CI 0.5) mm Hg min-1 for the control arm and 2.4 (95% CI 0.4) mm Hg min-1 for the THRIVE arm.
Conclusion:
Transnasal humidified rapid-insufflation ventilatory exchange prolongs the safe apnoea time in healthy children but has no effect to improve CO2 clearance.
Clinical Trial Registration:
ACTRN12615001319561.
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