AUTHOR=Chen Lingke , Yang Liu , Tian Weitian , Zhang Xiao , Zhao Yanhua , Huang Lili , Tian Jie , Zhang Jiaqiang , Wu Jiangxia , Yu Weifeng , Su Diansan 

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

JOURNAL=Frontiers in Medicine

VOLUME=7

YEAR=2020

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.577891

DOI=10.3389/fmed.2020.577891

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> 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.</p><p><bold>Methods:</bold> 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<sub>2</sub> and PaCO<sub>2</sub> at 20 min after apnea, with noninferiority margin criteria of −6.67 and 0.67 kPa, respectively.</p><p><bold>Results:</bold> A total of 123 patients completed the trial: 61 in the NPA group and 62 in the jaw thrust group. PaO<sub>2</sub> 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 &gt; −6.67 kPa, noninferiority was established because higher PO<sub>2</sub> is better. PaCO<sub>2</sub> 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 &lt;0.67 kPa, noninferiority was established because lower PCO<sub>2</sub> is better. No patient had a SpO<sub>2</sub> &lt; 90% during apnea.</p><p><bold>Conclusion:</bold> 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<sub>2</sub> and PaCO<sub>2</sub> at 20 min after apnea.</p><p><bold>Clinical Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link> (NCT03741998).</p>