Transnasal Humidified Rapid Insufflation Ventilatory Exchange With Nasopharyngeal Airway Facilitates Apneic Oxygenation: A Randomized Clinical Noninferiority Trial

Frontiers in Medicine

article

Lingke Chen¹  Weifeng Yu¹  Diansan Su¹  Liu Yang¹  Weitian Tian¹  Xiao Zhang¹  Yanhua Zhao¹  Lili Huang¹  Jie Tian¹  Jiaqiang Zhang²  Jiangxia Wu² 

[1] Department of Anaesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine;Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University

关键词: apneic oxygenation;    arterial blood gas;    general anesthesia;    nasopharyngeal airway;    THRIVE;   

DOI  :  10.3389/fmed.2020.577891

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

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 PaO 2 and PaCO 2 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. PaO 2 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 PO 2 is better. PaCO 2 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 PCO 2 is better. No patient had a SpO 2 < 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 PaO 2 and PaCO 2 at 20 min after apnea. Clinical Trial Registration:ClinicalTrials.gov ( {"type":"clinical-trial","attrs":{"text":"NCT03741998","term_id":"NCT03741998"}} NCT03741998 ).

【 授权许可】

CC BY