title: A randomised controlled trial comparing transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation with facemask pre-oxygenation in patients undergoing rapid sequence induction of anaesthesia.
abstract: Pre-oxygenation is an essential part of rapid sequence induction of general anaesthesia for emergency surgery, in order to increase the oxygen reservoir in the lungs. We performed a randomised controlled trial of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation or facemask pre-oxygenation in patients undergoing emergency surgery. Twenty patients were allocated to each group. No patient developed arterial oxygen saturation < 90% during attempted tracheal intubation. Arterial blood gases were sampled from an arterial catheter immediately after intubation. The mean (SD) PaO2was 43.7 (15.2) kPa in the THRIVE group vs. 41.9 (16.2) kPa in the facemask group (p = 0.722); PaCO2was 5.8 (1.1) kPa in the THRIVE group vs. 5.6 (1.0) kPa in the facemask group (p = 0.631); arterial pH was 7.36 (0.05) in the THRIVE group vs. 7.34 (0.06) in the facemask group (p = 0.447). No airway rescue manoeuvres were needed, and there were no differences in the number of laryngoscopy attempts between the groups. In spite of this, patients in the THRIVE group had a significantly longer apnoea time of 248 (71) s compared with 123 (55) s in the facemask group (p < 0.001). Transnasal humidified rapid insufflation ventilatory exchange is a practicable method for pre-oxygenating patients during rapid sequence induction of general anaesthesia for emergency surgery; we found that it maintained an equivalent blood gas profile to facemask pre-oxygenation, in spite of a significantly longer apnoea time.
authors.affiliation: Department of Anaesthesia, St George's University Hospital NHS Foundation Trust, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Mir
authors.affiliation: Department of Anaesthesia, The Royal National Throat Nose and Ear Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Anaesthesia, St George's University Hospital NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Iqbal
authors.affiliation: Department of Anaesthesia, St George's University Hospital NHS Foundation Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Cecconi
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University College Hospital NHS Foundation Trust, London, UK.
authors.forename: S A R
authors.initials: SA
authors.lastname: Nouraei
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D058109:Airway Management / Q000379:methods; D000769:Anesthesia, Inhalation / Q000009:adverse effects / Q000379:methods*; D001049:Apnea / Q000453:epidemiology / Q000209:etiology; D001784:Blood Gas Analysis; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D007828:Laryngoscopy; D008297:Male; D008397:Masks; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods*
keywords: oxygen transport: quantitative aspects; tissue oxygen delivery: factors impacting