Comparative efficacy of NO-DESAT and THRIVE for peri-oxygenation in patients with anticipated difficult airway

Pre-oxygenation followed by "apnoeic oxygenation" is an effective strategy for prolonging the safe duration of apnoea. This study aimed to compare the efficacy of nasal oxygen during efforts securing a tube (NO-DESAT) and transnasal humidified rapid insufflation ventilatory exchange (THRIVE) for oxygenation, ventilation, patient comfort, and cost of oxygen consumed in patients with anticipated difficult airway.

After obtaining institutional ethics committee approval, 40 consenting adult patients with American Society of Anesthesiologists (ASA) physical status I-III scheduled for surgery under general anaesthesia with anticipated difficult airway were recruited. They received facemask pre-oxygenation at 10 L/min till laryngoscopy in addition to nasal oxygen through a simple nasal cannula at the rate of 15 L/min (group N) or THRIVE at 30 L/min for one minute followed by 60 L/min until intubation (group T). Arterial samples were drawn at baseline, after pre-oxygenation and intubation. The primary outcome was the partial pressure of oxygen (PaO₂). The secondary outcomes included ventilation, patient comfort with the device, and cost of oxygen consumed. Data were recorded and analysed using Statistical Package for the Social Sciences version 20.0, and P value < 0.05 was taken as significant.

Mean PaO₂ (P = 0.926) and PaCO2 (P = 0.289) were comparable, but the pH was lower in group T than in group N (P < 0.001). The device tolerance was comparable, but the cost of oxygen consumed was three times in group T compared to group N.

Both NO-DESAT and THRIVE are equally efficacious for peri-oxygenation. However, NO-DESAT should be preferred for its cost-effectiveness.