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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

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High-velocity nasal insufflation with oxygen assist module versus conventional high-velocity nasal insufflation after

Suharit Visuthisakchai¹, Patharapan Lersritwimanmaen¹, Nuttapol Rittayamai¹

¹Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Journal of Thoracic Disease

|February 20, 2025

Abstract

Background:

The current technology of high-velocity nasal insufflation (HVNI) can be equipped with an oxygen assist module (OAM) that continuously monitors and automatically adjusts the inspired oxygen fraction (FiO₂) to maintain oxygen saturation by pulse oximetry (SpO₂) within the target range. This study aimed to evaluate the use of HVNI with OAM compared to conventional HVNI in patients after endotracheal extubation.

Methods:

This randomized crossover study enrolled 16 mechanically ventilated subjects who were ready to wean. The subjects were randomized to protocol A (HVNI with OAM for 60 min, followed by conventional HVNI for another 60 min) or protocol B (conventional HVNI for 60 min, followed by HVNI with OAM for another 60 min) after extubation. In HVNI with OAM, the target SpO₂ was set at 94% with a range of 92-98%, temperature of 37 °C and flow rate of 40 L/min. In the conventional HVNI group, the attending physician adjusted the FiO₂ to maintain an SpO₂ of at least 94%. The primary outcome was the time in the SpO₂ range between the two groups. The secondary outcomes included FiO₂, transcutaneous carbon dioxide pressure (PtcCO₂), respiratory rate oxygenation (ROX) index, and hemodynamic variables.

Results:

HVNI with OAM significantly maintained SpO₂ within the target range compared to conventional HVNI [99.4% (97.4-99.8%) vs. 5.3% (1.5-68.1%); P=0.001]. The use of FiO₂ was significantly lower and the ROX index was significantly higher at the end of the study in the HVNI with OAM group than in the conventional HVNI group [0.22 (0.21-0.25) vs. 0.40 (0.40-0.40); P=0.001 and 22.26 (15.94-26.46) vs. 13.01 (10.72-14.66); P=0.001, respectively]. No differences in breathing frequency, PtcCO₂ or hemodynamic variables were observed between the two groups.

Conclusions:

HVNI with OAM can maintain SpO₂ within the target range while using a lower FiO₂ and providing a higher ROX index than conventional HVNI in patients after extubation.

Trial Registration:

This study was registered in the Thai Clinical Trial Registry (TCTR20220801007) before the inclusion of the first patient.

Keywords:

Endotracheal extubation high-velocity nasal insufflation (HVNI)hypoxemia oxygen assist module (OAM)respiratory rate oxygenation index (ROX index)

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