title: Preoxygenation and apneic oxygenation using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange for emergency intubation.
abstract: Hypoxia is one of the leading causes of anesthesia-related injury. In response to the limitations of conventional preoxygenation, Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) has been used as a method of providing both preoxygenation and apneic oxygenation during intubation.
  
  
  
  In this prospective, observational study, THRIVE was introduced in a critical care unit (CCU), operating room (OR), and emergency department (ED) during emergency intubation of patients at high risk of hypoxia. Linear regression analysis tested for correlation between apnea time or body mass index and hemoglobin saturation (Spo2).
  
  
  
  Across 71 sequential patients, the interquartile range for apnea time and decrease in Spo2were 60 to 125 seconds and 0% to 3%, respectively. Significant desaturation occurred in 5 (7%) patients. There was no evidence of correlation between apnea time or body mass index and Spo2(R2=0.04 and 0.08 for CCU/ED and OR and 0.01 and 0.04 CCU/ED and OR, respectively). There were no complications reported from using THRIVE.
  
  
  
  This study demonstrated that preoxygenation and apneic oxygenation using THRIVE were associated with a low incidence of desaturation during emergency intubation of patients at high risk of hypoxia in the CCU, OR, and ED. THRIVE has the potential to minimize the risk of hypoxia in these patient groups.
authors.affiliation: Barts and the London School of Anaesthesia, The Royal London Hospital, Whitechapel, London, UK; William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK. Electronic address: ajdoyle@gmail.com.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Doyle
authors.affiliation: Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, King's Lynn, UK. Electronic address: danielstolady@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Stolady
authors.affiliation: Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, King's Lynn, UK. Electronic address: maryannemariyaselvam@gmail.com.
authors.forename: Maryanne
authors.initials: M
authors.lastname: Mariyaselvam
authors.affiliation: Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, King's Lynn, UK. Electronic address: gwijewardena@hotmail.com.
authors.forename: Gayathri
authors.initials: G
authors.lastname: Wijewardena
authors.affiliation: Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, King's Lynn, UK. Electronic address: emma_gent@doctors.org.uk.
authors.forename: Emma
authors.initials: E
authors.lastname: Gent
authors.affiliation: Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, King's Lynn, UK. Electronic address: markblunt@me.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Blunt
authors.affiliation: Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, King's Lynn, UK. Electronic address: peteryoung101@googlemail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D001049:Apnea / Q000628:therapy*; D003422:Critical Care; D004630:Emergencies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D012121:Respiration, Artificial
keywords: Apneic oxygenation; Complications; Emergency intubation; Hypoxia; Patient safety; Preoxygenation