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

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. To observe transnasal humidified rapid-insufflation ventilatory exchange in sedated gastroscopy in children and its effect on the incidence of hypoxemia. A prospective randomized clinical trial. Endoscopy Center in Shenzhen Children's Hospital. 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. The participants were randomly assigned in a 1:1 ratio to receive transnasal humidified rapid-insufflation ventilatory exchange or nasal cannula oxygen therapy. 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. 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. Transnasal humidified rapid-insufflation ventilatory exchange can promote oxygenation reducing the incidence of hypoxemia in sedated gastroscopy in children. ChiCTR2200060799. - THRIVE can reduce the work of breathing and improve oxygenation in children. - THRIVE can provide positive respiratory and continuous positive airway pressure, thereby promoting end-respiratory alveolar dilation. - THRIVE ensures oxygenation during short duration paediatric gastroscopy.