Authors: (including presenting author): :
LI MK(1), AU Yeung CH (1)
Affiliation: :
Intensive Care Unit, Yan Chai Hospital
Keyword 1: :
Rapid sequence induction
Keyword 2: :
Transnasal humified rapid ventilatory exchange
Keyword 3: :
Preoxygenation
Keyword 4: :
High flow nasal cannula
Keyword 5: :
High flow oxygen
Keyword 6: :
Endotracheal intubation
Introduction: :
Intubation is essential for critically ill patients with compromised airways, respiratory failure, or reduced consciousness. Rapid Sequence Induction (RSI) is the standard pre-intubation technique in acute care, but it induces apnea, risking hypoxia and death. Safe apnea time—maintaining SpO2 ≥90%—is crucial and achieved via preoxygenation. Traditional methods, per Hong Kong's Hospital Authority guidelines, involve 3-5 minutes with Bag-Valve Mask (BVM) or Non-Rebreathing Mask (NRM). However, Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE), or High-Flow Nasal Cannula (HFNC), is a emerging alternative. It delivers high-flow, humidified oxygen, enabling apneic ventilation to extend safe apnea time and reduce desaturation risks, as evidenced by clinical studies. This abstract investigates THRIVE's role in RSI preoxygenation, highlighting its potential as a safer, more effective option over conventional devices.
Objectives: :
-To enhance oxygenation before intubation under RSI -To extend the duration of safe apnea during the intubation process -To evaluate the safety of utilizing this novel device for preoxygenation
Methodology: :
Methodology: Before intubation, patients undergo 3-5 minutes of preoxygenation using High-Flow Nasal Cannula (HFNC) devices like Servo U or AIRVO2 , set at 60 L/min flow, 100% FiO2, and 37°C temperature. A medium-sized nasal cannula minimizes air contamination, and HFNC remains in place during laryngoscopy and intubation to support apneic ventilation. After at least 3 minutes, induction medications are given, initiating apneic oxygenation. Intubation begins 30-45 seconds later, aligning with the paralytic agent's onset (succinylcholine or rocuronium). Procedure completion is confirmed by correct endotracheal tube placement via quantitative end-tidal CO2 (ETCO2) monitoring. The Philips IntelliVue MX100 monitor tracks ETCO2 and SpO2 continuously, including waveform tracing. SpO2 values are recorded with timestamps before preoxygenation, at induction start, and upon intubation completion. Procedure duration is logged from the monitor, while intubation attempts are evaluated by the bedside nurse and physician.
Result & Outcome: :
Quantitative Measures Statistical Analysis: ●Oxygenation Enhanced:Patient used HFNC for preoxygenation with marked oxygenation enhancement noted ● Safe Apnea Duration Extended: Zero% desaturation levels (below 95%, 90%, 80%) noted. and 100% patient maintained SpO2 ≥ 90% during the peri-intubation period. ● Nil Adverse Events (including death, cardiac arrest, SpO2< 80%, severe hypotension defined as systolic blood pressure< 80 mmHg, initiation of vasopressors, or a 30% increase in dosage) encountered. Qualitative Measures ● Staff feedback on the THRIVE intubation technique was collected through questionnaires assessing nursing staff's perceptions of using THRIVE. 92% of nursing staff reported a significant reduction in concerns about aspiration when using THRIVE and nearly 100% demonstrated confidence in its implementation.
