Nasal High Flow Apnoeic Oxygenation during Paediatric Emergency Intubation: A Randomized Controlled Trial
Shane George, PhD
BACKGROUND: Emergency intubation for resuscitation of critically ill children in the emergency department (ED) or intensive care unit (ICU) is associated with a high rate (20-40%) of life-threatening adverse events. We have recently shown that the safe apnoeic time can be significantly improved with a novel technique, called Trans-nasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE).
GAP: The THRIVE apneic oxygenation technique has not been studied in the pediatric emergency or intensive care setting, where children are more likely to have significant physiological derangement and a higher rate of adverse event and unsuccessful intubation.
HYPOTHESIS: THRIVE reduces the frequency of dangerous and life-threatening oxygen desaturation and increases frequency of first attempt success in emergent intubation of children compared with standard practice. Use of THRIVE compared to standard intervention is cost-effective and leads to reduced health care costs in children requiring emergency intubation.
METHODS: Participating departments will randomise children being intubated in a 1:1 ratio to either standard care or THRIVE intervention groups, stratified by age ( 1 year, 1-7 years, 7 years), by operator experience and site. Children randomised to the standard care treatment arm will be intubated as per site specific procedures/guidelines at clinician preference. Children in the THRIVE treatment arm will be provided weight based high-flow apnoeic oxygenation with an FiO2 of 1.0 using Optiflow™ THRIVE device.
IMPACT: This study aims to create high-grade evidence to demonstrate that THRIVE can reduce the frequency of hypoxia and increase first attempt success during emergency intubation. The results of this study can be rapidly translated in clinical practice and improve child centred outcomes.