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Transnasal Humidified Rapid Insufflation Ventilatory Exchange in children requiring emergent intubation (Kids
Shane George1,2,3, Kristen Gibbons4, Tara Williams4,5
1Departments of Emergency Medicine, Children's Critical Care, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, Australia. shane.george@uq.edu.au.
Insights
Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) may improve intubation success in critically ill children. This trial investigates THRIVE versus standard care to reduce desaturation and increase first-attempt success during emergent pediatric intubation.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Respiratory Physiology
Background:
- Pediatric endotracheal intubation is high-risk, with frequent first-attempt failures and adverse events like hypoxemia.
- Apneic oxygenation aims to extend intubation time, but evidence in critically ill children is limited.
- Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) has shown promise in healthy children.
Purpose of the Study:
- To evaluate the efficacy of THRIVE in reducing oxygen desaturation during emergent pediatric intubation.
- To determine if THRIVE increases the rate of first-attempt intubation success without hypoxemia in children.
- To assess secondary outcomes including adverse events and resource utilization.
Main Methods:
- A multicenter, international, randomized controlled trial (RCT) involving children under 16 years undergoing emergent intubation.
- Participants randomized to either THRIVE (high-flow nasal oxygen) or standard care (no apneic oxygenation).
- Detailed statistical analysis plan for primary and secondary objectives.
Main Results:
- The study aims to determine if THRIVE reduces oxygen desaturation frequency.
- The primary outcome is to assess if THRIVE increases first-attempt intubation success without hypoxemia.
- Secondary outcomes include adverse event rates, mechanical ventilation duration, and ICU length of stay.
Conclusions:
- The Kids THRIVE trial will provide crucial data on the effectiveness of THRIVE in emergent pediatric intubation.
- Findings will inform clinical practice regarding apneic oxygenation techniques in critically ill children.
- This study addresses a significant knowledge gap in pediatric emergency and critical care.
Abstract:
The placement of an endotracheal tube for children with acute or critical illness is a low-frequency and high-risk procedure, associated with high rates of first-attempt failure and adverse events, including hypoxaemia. To reduce the frequency of these adverse events, the provision of oxygen to the patient during the apnoeic phase of intubation has been proposed as a method to prolong the time available for the operator to insert the endotracheal tube, prior to the onset of hypoxaemia. However, there are limited data from randomised controlled trials to validate the efficacy of this technique in children. The technique known as transnasal humidified rapid insufflation ventilatory exchange (THRIVE) uses high oxygen flow rates (approximately 2 L/kg/min) delivered through nasal cannulae during apnoea. It has been shown to at least double the amount of time available for safe intubation in healthy children undergoing elective surgery. The technique and its application in real time have not previously been studied in acutely ill or injured children presenting to the emergency department or admitted to an intensive care unit. The Kids THRIVE trial is a multicentre, international, randomised controlled trial (RCT) in children less than 16 years old undergoing emergent intubation in either the intensive care unit or emergency department of participating hospitals. Participants will be randomised to receive either the THRIVE intervention or standard care (no apnoeic oxygenation) during their intubation. The primary objective of the trial is to determine if the use of THRIVE reduces the frequency of oxygen desaturation and increases the frequency of first-attempt success without hypoxaemia in emergent intubation of children compared with standard practice. The secondary objectives of the study are to assess the impact of the use of THRIVE on the rate of adverse events, length of mechanical ventilation and length of stay in intensive care. In this paper, we describe the detailed statistical analysis plan as an update of the previously published protocol.
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