Optimizing High Flow Nasal Cannula Oxygenation in Pediatric Airway Procedures: A Randomized Study
Transnasal humidified rapid insufflation ventilator exchange (THRIVE) is defined as a technique that uses warmed and humidified oxygen administered via high-flow nasal cannula (HFNC) to achieve longer apneic times and prevent desaturation.
The small-bore interface provides a higher velocity gas at any given flow rate and penetrates to a deeper level of the airspace, allowing for more efficient gas exchange compared to standard nasal cannulas.
Even though HFNC has been found in several studies to be effective and safe compared to standard of care, optimal flow rates for the pediatric population have not been well defined.
Our study will utilize HFNC in pediatric otolaryngology airway procedures, randomized to higher or lower flow rates in order to determine optimal rates
Purpose & Aim
Population of the study: Children (0-17 years) undergoing elective pediatric airway procedures
Intervention: Randomized into HFNC higher flow group (2L/kg per min with max of 45L) versus lower flow group (0.5L/kg per min with max of 5L)
Exclusion: Emergency type cases, tracheostomy patients, unrepaired cyanotic heart disease, nasal deformity/choanal atresia, or cautery/laser type procedures
Comparison: To investigate which flow rate (higher versus lower) is most effective at increasing apneic time and preventing greater than 5% drop in desaturation, as well as assessing transcutaneous CO2 levels during airway procedures
Outcomes:
Primary outcomes
• Incidence of desaturation >5 % from baseline
Secondary outcomes
• Apnea time
• Number of surgery interruptions
• Airway intervention to rectify desaturation <90% and transcutaneous CO2 >20% from baseline (intubation, masking, or other airway device)
• Oxygen nadir level
• Transcutaneous CO2 measurements throughout procedure
Trial Information
Target Enrollment: 80 patients with 40 in each flow rate group (higher or lower flow rate will be randomized)
Children (0-17 years) undergoing elective pediatric airway procedures
Sponsor: None -PI initiated
Funder: None
Duration of Study: 2 years
Study Principal Investigator
Zhen Huang, MD, MBA
Associate Professor Non-Tenure Clinical
Otorhinolaryngology H&N Surgery
6431 Fannin St, MSB 5.036
Houston, TX 77030
Links
Clinical Trials link https://clinicaltrials.gov/study/NCT06947902?term=NCT06947902&rank=1