A Randomised Controlled Trial of Apnoeic Oxygenation With No-flow vs High-flow vs Ultra High-flow Nasal Oxygen
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Apnea
- Sponsor
- University College Hospital Galway
- Enrollment
- 114
- Locations
- 1
- Primary Endpoint
- Rise in arterial partial pressure of carbon dioxide
- Status
- Completed
- Last Updated
- 3 years ago
Overview
Brief Summary
Apnoeic oxygenation refers to oxygenation that occurs through the insufflation of oxygen into the lungs in the absence spontaneous respiration or positive pressure ventilation. It is used to extend the time to desaturation at induction of anaesthesia and as a primary oxygenation technique during airway surgery. The impact of high-flow nasal oxygen flow rate selection on gas exchange is poorly understood. Participants in this study will be randomised to receive a certain nasal oxygen flow rate during apnoea and its effect on gas exchange will be measured by blood gas analysis.
Detailed Description
Apnoeic oxygenation with high-flow nasal oxygen has been proposed to result in carbon dioxide clearance. However, this has been poorly quantified. This study will compare use of nasal oxygen at different flow rates during apnoea with that of a control that does not receive nasal oxygen. Participants are anaesthetised after standardised pre-oxygenation with high-flow nasal oxygen, after which they will receive one of three nasal oxygen flow rates (0, 70, 120 L/min). The rate of carbon dioxide elevation will be measured by arterial blood gas analysis after the onset of apnoea and compared between the three groups to discern the relative rates of carbon dioxide clearance after the first minute of apnoea. The effect of nasal oxygen flow rate on oxygenation will also be measured.
Investigators
John Laffey
+Michael Callaghan - principal investigator
University College Hospital Galway
Eligibility Criteria
Inclusion Criteria
- •18 years of age or older
- •ASA 1 or 2
- •Receiving a general anaesthetic for non-emergent surgery
Exclusion Criteria
- •ASA score ≥3
- •BMI ≥ 30 kg/m2
- •Nasal obstruction
- •Baseline SpO2 ≤95% on room air
- •Anticipated difficult airway management
- •Requirement for awake intubation
- •Pregnancy
- •Positive PCR test for coronavirus in preceding 14 days.
Outcomes
Primary Outcomes
Rise in arterial partial pressure of carbon dioxide
Time Frame: Between 1 and 4 minutes of apnoea
The rate of rise of the partial pressure of carbon dioxide between 60 seconds and 240 seconds of apnoea as measured by arterial blood gas analysis.
Secondary Outcomes
- Time to oxygen desaturation(Immediately after the intervention)
- Partial pressure of oxygen during apnoea(Following high-flow nasal oxygen administration)
- Change in carbon dioxide elevation before and after HFNO administration(Between 3 and 5 minutes of apnoea)
- Carbon dioxide elevation during the first minute of apnoea(Between 0 and 1 minute of apnoea)
- Change in acid-base status during apnoea(At 1 minute intervals during apnoea)