Transnasal Humidified Rapid Insufflation Ventilatory Exchange in Morbidly Obese
NCT ID: NCT03550924
Last Updated: 2020-09-02
Study Results
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Basic Information
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COMPLETED
NA
40 participants
INTERVENTIONAL
2018-07-26
2020-01-22
Brief Summary
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Detailed Description
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Several measures such as positioning in a semi sitting position, preoxygenation with PEEP and passive insufflation of oxygen during laryngoscopy have been shown to prolong the DAWD. None of these measures is able to produce positive endexpiratory pressure (PEEP) during laryngoscopy which would counteract the loss of FRC and therefore prolong the DAWD further.
Transnasal humidified rapid insufflation ventilator exchange (THRIVE, also knowns as "high flow nasal oxygen therapy" and "heated and humidified nasal oxygen") devices have been used for several years in intensive care and are available from numerous vendors. With THRIVE, heated and humidified oxygen is insufflated via nasal prongs at a rate up to 120 l/minute and it has been shown that this creates levels of PEEP, proportional to the amount of gas flow. Using THRIVE during the apneic phase of anesthesia induction in obese patients might be superior compared to low flow oxygen techniques as THRIVE generates PEEP during laryngoscopy, which might counteract the loss of FRC and consequently might prolong the DAWD.
Aim of the project This project will investigate the DAWD when using THRIVE vs. low flow nasal oxygen at anesthesia induction in obese patients.
Hypothesis The duration of apnea without desaturation is longer in the "THRIVE" group compared to the "low flow oxygen" group.
Methods The study will be conducted as a single center, prospective, randomized, controlled trial at the Medical University of Vienna, Austria.
Forty adult patients of the ASA classification 2 and 3 with a BMI \>40 undergoing elective surgery under general anesthesia will be included. Patients with expected difficult airway, patients with an oxygen saturation \<98% despite preoxygenation, patients with nasal obstruction, smokers (\>10 cigarettes/day), patients with chronic respiratory disease, patients unable to give consent, and pregnant or breastfeeding patients will be excluded.
Patients will be randomly assigned to one of two groups ("low flow oxygen" or "THRIVE" group) and anesthesia will be induced in a standardized fashion in both groups. During laryngoscopy, patients in the low flow group will receive nasal oxygen insufflation at a rate of 10 l/min and patients in the THRIVE group will receive oxygen at a rate of 120 l/min via a THRIVE system. Difficult laryngoscopy will be simulated and intubation will be performed as soon as oxygen saturation drops to 95%. The time from anesthesia induction until oxygen saturation drops to 95% (DAWD) will be measured.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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Low flow Oxygen Group
low flow passive oxygenation during laryngoscopy with 10l/min oxygen via standard nasal prongs
low flow passive oxygenation
low flow passive oxygenation during laryngoscopy with 10l/min oxygen via standard nasal prongs
THRIVE Group
high flow passive oxygenation during laryngoscopy with 120l/min oxygen via THRIVE system
high flow passive oxygenation
high flow passive oxygenation during laryngoscopy with 120l/min oxygen via THRIVE system
Interventions
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low flow passive oxygenation
low flow passive oxygenation during laryngoscopy with 10l/min oxygen via standard nasal prongs
high flow passive oxygenation
high flow passive oxygenation during laryngoscopy with 120l/min oxygen via THRIVE system
Eligibility Criteria
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Inclusion Criteria
* American Society of Anesthesiologists physical status classification class 2-3
* BMI \> 40
* elective surgery under general anesthesia
Exclusion Criteria
* oxygen saturation of less than 98% despite adequate preoxygenation,
* nasal obstruction
* smoker, more than 10 cigarettes per day
* chronic respiratory disease
* FEV1 (forced expiratory volume in one second) \< 70%
* elevated intracranial pressure
* unable to give informed consent
* Pregnant or breast feeding
19 Years
65 Years
ALL
No
Sponsors
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Medical University of Vienna
OTHER
Responsible Party
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Thomas Hamp
Principal Investigator
Principal Investigators
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Thomas Hamp, Doctor
Role: PRINCIPAL_INVESTIGATOR
Department of Anaesthesia and Intensive Care Medicine
Locations
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Medical University of Vienna
Vienna, , Austria
Countries
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Other Identifiers
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2270/2017
Identifier Type: -
Identifier Source: org_study_id
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