NDLI: Apneic oxygenation with Transnasal Humidified Rapid-insufflation Ventilator Exchange (THRIVE) in obstructive sleep apnea patients: study protocol of a randomized controlled trial

Content Provider	Springer Nature : BioMed Central
Author	Lei, Guiyu Wu, Lili Xi, Chunhua Yang, Siliu Yang, Qingwen Su, Shaofei Wang, Guyan
Abstract	Background Patients with obstructive sleep apnea (OSA) are at increased risks of rapid oxygen desaturation during anesthesia, highlighting the need for effective strategies to extend safe apnea time. This study aims to evaluate the efficacy of combining a nasopharyngeal airway (NPA) with transnasal humidified rapid-insufflation ventilator exchange (THRIVE) at 60L/min, compared to THRIVE alone, in prolonging the safe apnea duration and enhancing carbon dioxide elimination in apneic OSA patients. Methods This single-center, prospective, double-blind, randomized controlled trial will include 56 adult patients with OSA scheduled for elective surgery under general anesthesia. Participants will be randomized in a 1:1 ratio to receive either NPA + THRIVE or THRIVE alone. Both groups will undergo standard anesthesia induction, including pre-oxygenation via face mask with 100% FiO2at 10 L/min. During apnea, patients in both groups will receive oxygen via Optiflow THRIVE at 60 L/min. The primary outcome is the time from the initiation of nasal oxygenation to a peripheral oxygen saturation (SpO2) of 95%. Secondary outcomes include the lowest SpO2 during intubation, plateau end-tidal CO2 (EtCO2) values, rate of increase of transcutaneous CO2 (tcCO2), and time to regain baseline SpO2 after resuming ventilation. Discussion This trial is expected to provide insights into the effectiveness of combining THRIVE with NPA in prolonging safe apnea time and improving carbon dioxide elimination in OSA patients during anesthesia induction. Positive findings could support adoption THRIVE + NPA as a standard practice in managing OSA patients, potentially lowering perioperative risks associated with hypoxia and hypercapnia. Trial registration This trial was registered on Clinical Trials.gov(NCT 06581588) on Sep 3, 2024.
Related Links	https://bmcanesthesiol.biomedcentral.com/counter/pdf/10.1186/s12871-025-03055-5.pdf
Ending Page	7
Page Count	7
Starting Page	1
File Format	HTM / HTML
ISSN	14712253
DOI	10.1186/s12871-025-03055-5
Journal	BMC Anesthesiology
Issue Number	1
Volume Number	25
Language	English
Publisher	BioMed Central
Publisher Date	2025-04-11
Access Restriction	Open
Subject Keyword	Anesthesiology Internal Medicine Emergency Medicine Intensive Critical Care Medicine Apneic oxygenation THRIVE Nasopharyngeal airway Obstructive sleep apnea Randomized controlled trial
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine
Journal Impact Factor	2.3/2023
5-Year Journal Impact Factor	2.6/2023

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