Effect of transnasal humidified rapid-insufflation ventilatory exchange on the incidence of hypoxemia in sedated gastroscopy in children: a randomised controlled trial

Abstract

Background: Transnasal humidified rapid-insufflation ventilatory exchange is a novel ventilation modality which can provide very high flow (up to 70 l/min) heated and humidified gas with adjustable temperatures (31-37 °C) and oxygen concentrations (21-100%). However its application in sedated gastroscopy in children has received little attention.

Objective: To observe transnasal humidified rapid-insufflation ventilatory exchange in sedated gastroscopy in children and its effect on the incidence of hypoxemia.

Design: A prospective randomized clinical trial.

Setting: Endoscopy Center in Shenzhen Children's Hospital.

Patients: 120 children (ASA grade I-II), aged 6-12 years with a body mass index of 18-25 kg m-2, who underwent sedated gastroscopy at Shenzhen Children's Hospital between June 2022 and November 2022.

Interventions: The participants were randomly assigned in a 1:1 ratio to receive transnasal humidified rapid-insufflation ventilatory exchange or nasal cannula oxygen therapy.

Main outcome measures: The primary outcome was hypoxemia incidence. The secondary outcomes included the lowest oxygen saturation index, duration of hypoxemia, incidence of adverse respiratory conditions, intervention rate, and endoscopist satisfaction.

Results: Five children (8.3%) in thetransnasal humidified rapid-insufflation ventilatory exchange group had hypoxemia compared with 17 (28.3%) in the nasal cannula group, with a significant difference (P<0.01). The lowest oxygen saturation index in two groups shows no significant difference [98 (95, 99) vs. 98 (90, 99), P=0.087]. However compared with the nasal cannula group, the duration of hypoxaemia was significantly shorter (9.00 ± 1.73 s vs. 13.18 ± 3.49 s, 95% CI -6.63 to -1.72; P<0.01), the intervention rate was significantly lower (n=7, 11% vs. n=18, 30%; P<0.05), the incidence of adverse breathing complications was significantly lower (n=8, 13.3% vs. n=18, 30%; P<0.05), and the satisfaction of endoscopists was significantly higher (88.3% vs. 68.3%, P<0.05) in the transnasal humidified rapid-insufflation ventilatory exchange group.

Conclusion: Transnasal humidified rapid-insufflation ventilatory exchange can promote oxygenation reducing the incidence of hypoxemia in sedated gastroscopy in children.

Trial registration: ChiCTR2200060799.

Fig. 1

Flow diagram of the eligibility, randomisation, and follow-up of participants

Fig. 2

The situation about the baseline SpO₂and the lowest SpO₂in two groups. (a) Box plot of baseline oxygen saturation (SpO₂) in the two groups (P=0.639). (b) Box plot of lowest SpO₂ in the two groups (P=0.087). THRIVE, transnasal humidified rapid-insufflation ventilatory exchange; NC, nasal cannula