Apneic Oxygenation Via Nasal Cannulae: 15 L/Min vs High-Flow
Condition: Apneic Oxygenation
MeSH terms: Apnea
Study type: Interventional
Phase: Phase 4

Summary: 
      This is a randomized clinical trial investigating the utility of apneic oxygenation via nasal
      cannulae in the post-induction setting for the purpose of prolonging the safe apneic time.
      Three groups will be compared, a control group at 0 L/min, a 15 L/min and a 60 L/min group.
      The primary outcome will be the difference in the partial pressure of oxygen in arterial
      blood (PaO2) between groups throughout the nine-minute apneic period.
    

Detailed description: 
      Airway management can be a life saving therapy. One major complication that may occur during
      airway management is a lack of oxygen in the blood. If severe or prolonged, this lack of
      oxygen can result in permanent brain damage, damage to other vital organs or even death.
      Strategies already exist to help prevent a lack of oxygen in the blood (hypoxemia), however
      research involving new ways to oxygenate patients may help to minimize the chance of
      hypoxemia during airway management. Apneic oxygenation is a novel method of delivering oxygen
      to a patient despite a lack of active respiration (i.e. the patient is not breathing on their
      own and the investigators are not providing the patient an artificial breath). The simplest
      and least invasive method to provide apneic oxygenation is the application of oxygen through
      nasal cannulae during airway management. Several different techniques to provide apneic
      oxygenation via nasal cannulae have been previously described(1-3), however randomized trials
      comparing these methods do not exist. This study will examine the change over time of the
      amount of oxygen dissolved in the blood (PaO2) in each of the three treatment groups: a
      control group (no apneic oxygenation), a 15 L/min group and a 60 L/min group. This data will
      help to determine the extent of benefit apneic oxygenation provides in this setting.
    

Intervention name(s): 0 L/min oxygen via conventional nasal cannulae; 15 L/min oxygen via conventional nasal cannulae; 60 L/min oxygen via high-flow nasal cannulae
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Patients will have conventional nasal cannulae placed under chin prior to induction of anesthesia. Immediately post-induction these will be placed into the nares. They will be removed from the nares at the end of the study when the airway has been secured. There will be no oxygen flowing through the cannulae in this group during the study.; Patients will have conventional nasal cannulae placed under chin prior to induction of anesthesia. Immediately post-induction these will be placed into the nares. They will be removed from the nares at the end of the study when the airway has been secured. There will be 15 L/min of oxygen flowing through the cannulae in this group during the study.; Patients will have high-flow nasal cannulae placed under chin prior to induction of anesthesia. Immediately post-induction these will be placed into the nares. They will be removed from the nares at the end of the study when the airway has been secured. There will be 60 L/min of oxygen flowing through the cannulae in this group during the study.
Other intervention name(s): 0 L/min apneic oxygenation; 15 L/min apneic oxygenation; 60 L/min apneic oxygenation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Tracheal intubation; High flow nasal oxygen; Airway management; Apneic oxygenation