Trans-nasal Humidified Rapid- Insufflation Ventilatory Exchange in Children Requiring Emergent Intubation (Kids THRIVE): A Randomised Controlled Trial.

Abstract

Children may present to an emergency department with life threatening conditions that require immediate treatment to support their breathing to allow enough oxygen to be supplied to the body. In these circumstances a child is anesthetized and intubated, this process is associated with a high risk for low oxygen levels (14%) in the body or low blood pressure or heart rate. Newer methods to avoid these risks and improve patient safety are important to investigate. In this study we investigate a new approach called Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE); to prevent a drop in oxygen levels during intubation using nasal high flow oxygen delivery. This method allows continued post induction oxygen delivery during attempted intubation, whereas once the face mask is removed during traditional intubation the oxygen reservoir is no longer renewed and lower O2 levels can occur. We have tested this method in children with healthy lungs undergoing anaesthesia for elective surgery, and we found that we can maintain oxygen levels more than twice as long as using standard intubation methods. These findings would allow the operator in emergency settings more time and a safer condition to secure the airway in a sick child. It is though that by providing oxygen throughout the intubation adverse events such as oxygen desaturation are reduced and he number of successful first intubation attempts increases. The high flow system used for the THRIVE method is not new and is often used in hospitals to treat children with respiratory illness such as bronchiolitis.

Therefore we aim to compare the addition of the THRIVE method to standard intubation practice with the current standard practice to intubate a child in an emergency situation. We aim to demonstrate that the new THRIVE method will reduce the risk for low oxygen levels in the blood and prevents low blood pressure associated with intubation.