Abstract
Background: Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) was used to extend the safe apnea time. However, THRIVE is only effective in patients with airway opening. Nasopharyngeal airway (NPA) is a simple device that can help to keep airway opening. This study aimed to investigate the noninferiority of NPA to jaw thrust for airway opening during anesthesia-induced apnea.Methods: This was a prospective randomized single-blinded noninferiority clinical trial on the use of THRIVE in patients with anesthesia-induced apnea. The participants were randomly allocated to receive NPA or jaw thrust. The primary outcomes were PaO2 and PaCO2 at 20 min after apnea, with noninferiority margin criteria of −6.67 and 0.67 kPa, respectively.Results: A total of 123 patients completed the trial: 61 in the NPA group and 62 in the jaw thrust group. PaO2 at 20 min after apnea was 42.9 ± 14.0 kPa in the NPA group and 42.7 ± 13.6 kPa in the jaw thrust group. The difference between these two means was 0.25 kPa (95% CI, −3.87 to 4.37 kPa). Since the lower boundary of the 95% CI was > −6.67 kPa, noninferiority was established because higher PO2 is better. PaCO2 at 20 min after apnea was 10.74 ± 1.09 kPa in the NPA group and 10.54 ± 1.18 kPa in the jaw thrust group. The difference between the two means was 0.19 kPa (95% CI, −0.14 to 0.53 kPa). Since the upper boundary of the 95% CI was <0.67 kPa, noninferiority was established because lower PCO2 is better. No patient had a SpO2 < 90% during apnea.Conclusion: When THRIVE was applied during anesthesia-induced apnea, NPA placement kept airway opening and was noninferior to jaw thrust in terms of its effects on PaO2 and PaCO2 at 20 min after apnea.Clinical Trial Registration: ClinicalTrials.gov (NCT03741998).
Highlights
Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) refers to a treatment method of continuously providing patients with adjustable and relatively constant oxygen concentration (21–100%), temperature (31–37◦C), and humidity with high flow (8–70 L/min) inhalation of gas through a nasal high-flow oxygen inhalation device
This study aimed to investigate the noninferiority of Nasopharyngeal airway (NPA) to jaw thrust for airway opening during anesthesia-induced apnea
When THRIVE was applied during anesthesia-induced apnea, NPA placement kept airway opening and was noninferior to jaw thrust in terms of its effects on PaO2 and PaCO2 at 20 min after apnea
Summary
Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) refers to a treatment method of continuously providing patients with adjustable and relatively constant oxygen concentration (21–100%), temperature (31–37◦C), and humidity with high flow (8–70 L/min) inhalation of gas through a nasal high-flow oxygen inhalation device. THRIVE was first introduced by Dr Patel in 2015 and was demonstrated to extend the apnea time to up to 65 min (1). A physiological study on apneic oxygenation during laryngeal surgery showed that the use of THRIVE enabled patients with mild systemic disease and body mass index (BMI)
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