Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) use in a pediatric population: A prospective, randomized controlled trial

Background Maintenance of oxygenation during microdirect laryngoscopy and bronchoscopy (MDLB) is an anesthetic challenge for pediatric anesthesia providers. High flow nasal cannula (HFNC) as transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a safe method to deliver humidified oxygen to pediatric patients; however, its role in pediatrics for preventing apneic desaturation while under anesthesia is unclear. This study evaluated THRIVE for pediatric patients undergoing airway procedures. The primary aim was to assess the frequency of patients who had at least one “relative desaturation” event, assessed as a 4 % drop from a patient's average baseline saturation using the measure of oxygen desaturation index (ODI). The secondary aims assessed frequencies of total relative desaturation events, absolute desaturations below 90 % and surgical interruptions due to airway conditions. Methods This was a prospective, randomized controlled trial conducted across three pediatric sites (Lucile Packard Children's Hospital [Stanford University, Palo Alto, CA], UC Davis Children's Hospital [University of California, Davis, CA], and Boston Children's Hospital [Harvard University, Boston, MA]). Participants between the ages of 2 months to 18 years underwent airway examinations or airway procedures under general anesthesia. Participants were randomized in a 1:1 ratio to THRIVE or standard of care (SOC). Results A total of 144 participants were included. ODI measurements of relative desaturation in the THRIVE group and SOC group showed no differences in number of the participants who ever desaturated ( p = 0.18). There was a difference in total number of relative desaturation events, accounting for multiple events per participant ( p = 0.04). There were no differences in surgical interruptions due to airway conditions. Conclusion THRIVE was not superior to SOC for reducing the number of patients who experienced desaturations or surgical interruptions, though it may have some benefit for reducing the total number of desaturation events in those who desaturate.