Transnasal humidified rapid‐insufflation ventilatory exchange ( THRIVE ) vs. facemask breathing pre‐oxygenation for rapid sequence induction in adults: a prospective randomised non‐blinded clinical trial

Summary Transnasal humidified rapid‐insufflation ventilatory exchange ( THRIVE ) can prolong apnoea time in adults. Therefore, THRIVE used for pre‐oxygenation in rapid sequence induction of anaesthesia could extend safe apnoea time during prolonged laryngoscopy and intubation. In this randomised controlled trial, we compared the lowest peripheral oxygen saturation (SpO 2 ) during intubation when pre‐oxygenating with either traditional facemask or THRIVE . Eighty adult patients, undergoing rapid sequence induction of anaesthesia for emergency surgery, were randomly allocated to pre‐oxygenation with 100% oxygen with facemask or with THRIVE . Median ( IQR [range]) lowest SpO 2 until 1 min after intubation was 99% (97–100 [70–100]%) for the facemask group vs. 99% (99–100 [96–100]%) for the THRIVE group (p = 0.097). Five patients (12.5%) desaturated below 93% when pre‐oxygenated with the facemask vs. none in the THRIVE group (p = 0.019). There were no differences in intubation time or apnoea time between the groups. Median intubation time was 51 (34–66 [22–261]) s in the facemask group vs. 48 (38–63 [10–146]) s in the THRIVE group (p = 0.99). Median apnoea time was 109 (86–142 [37–291]) s and 116 (92–146 [63–249]) s when using facemask and THRIVE , respectively (p = 0.49). No signs of regurgitation of gastric content were detected. The data on desaturation indicate potential benefits of oxygenation with THRIVE for rapid sequence induction compared with facemask pre‐oxygenation.