High-flow for Children's Airway Surgery: a Randomized Controlled Trial
Susan Humphreys, MB ChB, FFARCSI, FANZCA
BACKGROUND: The balance of adequate depth of anesthesia with maintenance of spontaneous breathing and adequate oxygenation during tubeless airway surgery for abnormal airways in children, is complex. 34% of children experience a hypoxemic event during the procedure and 23% require an interruption of procedure for rescue oxygenation via delivery of a positive pressure thereby prolonging anesthesia time, reducing surgical efficiency and prolonging hospital stay. GAP: HIGH-FLOW has been shown to prolong the safe saturation time of children during apnea and during spontaneous breathing for airway procedures. The technique has been implemented in adult practice but needs evaluation in children with abnormal airways. The HIGH-FLOW technique has not been studied in children requiring tubeless airway surgery known to be at risk of severe hypoxemia and require rescue oxygenation. HYPOTHESIS: The heated and humidified 100% nasal oxygen using HIGH-FLOW oxygenation will reduce hypoxemic events compared to traditional LOW-FLOW techniques, during anesthesia for elective tubeless upper airway surgery in spontaneously breathing children METHODS: A multicenter randomized controlled trial in five Australian tertiary children’s hospitals evaluating efficacy of HIGH-FLOW during tubeless airway surgery in children with abnormal airways. 530 children aged from 0-16 years presenting for elective tubeless airway surgery in participating tertiary referral children’s hospitals. RESULTS: Pending. IMPACT: Findings will inform best practice for anesthesia for children with abnormal airways and will have rapid uptake by children’s hospitals and be published in a high- ranking international journal. The results will have an immediate translational impact on health care service provision.