When a child presents to an emergency department, or is admitted to the intensive care unit because of a life-threatening condition, they may need immediate treatment to support their breathing. In these circumstances a child is given medication to put them to sleep and the airway is secured with the insertion of a tube into the windpipe. This transition from spontaneous breathing when a child is awake to controlled respiration under anaesthetic via a breathing tube is called intubation. This procedure is technically challenging and is often associated with low oxygen levels in children.
New methods of intubation which reduce the risk of oxygen levels becoming low are continually developed and safely tested through clinical trials. The Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange in children requiring emergency intubation (Kids THRIVE) is one of these clinical trials. In this study, we investigated a new approach to prevent a drop in oxygen levels during intubation using high flow oxygen delivery. We tested this method in children with healthy lungs undergoing anaesthesia for elective surgery and we found that we can maintain oxygen levels more than twice as long as using standard intubation methods. These findings would allow the operator in emergency settings more time and a safer condition to secure the airway in a sick child.
By comparing the current standard practice for intubating a child in an emergency situation, we aim to demonstrate that the THRIVE method will reduce the risk for low oxygen levels in the blood and increase the likelihood that the treating doctor is able to insert the breathing tube on the first attempt.
- Thrasher Research Foundation: US$370,000 (~AU$500,000) [George S, Schibler A, Humphreys S, Gibbons K, Gannon B, Gelbart B. (2018) Nasal High Flow Apnoeic Oxygenation during Paediatric Emergency Intubation: A Randomised Controlled Trial.]
- Gold Coast Health and Gold Coast Hospital Foundation: $75,410 [Weir K, George S, Reilly S, Grimwood K, Moloney S , Hong T, Chauhan M, Canning A, Oorloff R, Ware R, Frakking T (2018). Oral feeding safety and aspiration risk in infants and children receiving nasal high flow nasal ventilation support.]
George S., Humphreys S., Williams T., Gelbart B., Chavan A., Rasmussen K., Ganeshalingham A., Erickson S., Ganu S.S., Singhal N., Foster K., Gannon B., Gibbons K., Schlapbach L.J., Festa M., Dalziel S., Schibler A., Paediatric Critical Care Research Group (PCCRG), Paediatric Research in Emergency Departments International Collaborative (PREDICT) and the Australia and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG), “Transnasal humidified rapid insufflation ventilatory exchange in children requiring emergent intubation (Kids THRIVE): a protocoll for a randomised controlled trial", BMJ Open, 2019 Feb 20;9(2):e025997. doi: 10.1136/bmjopen-2018-025997
Byrne, L., Obonyo, N.G., Diab, S., Dunster, K., Passmore, M., Boon, A.C., Hoe, L.S., Hay, K., Van Haren, F., Tung, J.P. and Cullen, L., 2018. An ovine model of hyperdynamic endotoxemia and vita
Humphreys S., Rosen D., Schibler A., “Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) technique in paediatric anaesthesia practice”, Australian Anaesthesia 2017, 2017; 43-48.l organ metabolism. Shock: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches, 49(1), pp.99-107.
George, S., Humphreys, S., Williams, T., Gelbart, B., Chavan, A., Rasmussen, K., Ganeshalingham, A., Erickson, S., Ganu, S.S., Singhal, N. and Foster, K., 2019. Transnasal Humidified Rapid Insufflation Ventilatory Exchange in children requiring emergent intubation (Kids THRIVE): a protocol for a randomised controlled trial. BMJ open, 9(2), p.e025997.
Humphreys, S., Lee-Archer, P., Reyne, G., Long, D., Williams, T. and Schibler, A., 2017. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a randomized controlled trial. BJA: British Journal of Anaesthesia, 118(2), pp.232-238.
Humphreys, S., Rosen, D., Housden, T., Taylor, J. and Schibler, A., 2017. Nasal high‐flow oxygen delivery in children with abnormal airways. Pediatric Anesthesia, 27(6), pp.616-620.
20th Annual Meeting on Clinical Trials in Intensive Care, March 6-8 2018, Noosa: Presentation - Shane George. Kids THRIVE.
Dr Shane George
A/Prof Andreas Schibler
Dr Katie Rasmussen
Dr Luke Burman
Dr Scott Simpson
Dr Susan Humphreys
Ms Kelly Foster