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Endotracheal intubation in infants often involves more than one attempt, and oxygen desaturation is common. It is unclear whether nasal high-flow therapy, which extends the time to desaturation during elective intubation in infants receiving general anesthesia, can decrease the occurence of desaturation during intubation.
The investigators tested the hypothesis that high-flow nasal oxygen cannulae would be effective in maintaining oxygen saturation during intubation than facemasks for pre-oxygenation. The investigators randomly allocated 132 patients undergoing elective surgery aged <=12 months to pre-oxygenation using either high-flow nasal oxygen or facemask.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| high flow nasal oxygen | Experimental |
| |
| face mask | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| high flow nasal oxygen | Procedure | In the intervention group, pre-oxygenation was provided using HFNO via Optiflow THRIVE™ (Fisher and Paykel Healthcare Limited, Auckland, New Zealand) until SpO2 on pulse oximetry was > 95% and for at least 3 min. A flow of 0.5 l/kg/min-1 was used until induction agents had been administered, and then increased to 2 l/kg/min-1. Nasal oxygenation was continued without ventilation of the lungs while waiting for neuromuscular blockade, and during placing, replacing or repositioning the airway. Anaesthetists were free to carry out bag-mask ventilation of the lungs if they considered this necessary to maintain safe oxygen saturations. After securing the airway, the patient was connected to a circle circuit primed with 100% oxygen and the FIO2 was continued at 100% for a period of at least five more minutes. Relevant times were recorded, including start of pre-oxygenation and start of induction of anaesthesia. |
| Measure | Description | Time Frame |
|---|---|---|
| Occurrence of oxygen desaturation <95% | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Occurrence of oxygen desaturation <90% | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. | |
| the lowest oxygen saturation | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Eun-hee Kim | Seoul National University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul national university hospital | Seoul | South Korea |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41557566 | Derived | Park JB, Ji SH, Jang YE, Lee JH, Kim JT, Kim HS, Kim EH. High-flow Nasal Oxygenation in Infants Undergoing Tracheal Intubation: A Single-center Randomized Controlled Trial. Anesthesiology. 2026 May 1;144(5):1105-1113. doi: 10.1097/ALN.0000000000005946. Epub 2026 Jan 20. |
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| ID | Term |
|---|---|
| D000860 | Hypoxia |
| ID | Term |
|---|---|
| D012818 | Signs and Symptoms, Respiratory |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D008397 | Masks |
| ID | Term |
|---|---|
| D058257 | Surgical Attire |
| D004865 | Equipment and Supplies, Hospital |
| D004864 | Equipment and Supplies |
| D011482 | Protective Devices |
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|
| face mask | Procedure | In the control group, pre-oxygenation was provided using 100% oxygen via a sealed facemask and a circle-absorber anaesthetic circuit primed with 100% oxygen by installing a ventilation bag to the mouthpiece filter and ventilating the circuit with 100% oxygen. Anaesthetists were free to carry out bag-mask ventilation of the lungs once induction medications had been administered. |
|
| the changes in oxygen reserve index | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| ETCO2 in first breath after intubation | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| ETO2 in first breath after intubation | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| Number of intubation attempts | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| Intubation times | time required to securing the airway. | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| Occurrence of rescue bag mask ventilation | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| Occurrence of gastric insufflation | from induction of anesthesia to 1 minutes after intubation, about 10 minutes. |
| D000067393 | Personal Protective Equipment |
| D013523 | Surgical Equipment |
| D008420 | Manufactured Materials |
| D013676 | Technology, Industry, and Agriculture |