High-flow oxygen for children's airway surgery: randomised controlled trial protocol (HAMSTER)

Susan Humphreys, Britta Sylvia von Ungern-Sternberg, Justin Skowno, Tara Williams, Julia Taylor, Fiona Taverner, Kristen Gibbons, Laura Burgoyne, David Sommerfield, Philip Stephens, Ben Hallett, Shyan Vijayasekaran, Nicola Slee, Hannah Burns, Marcin Sowa, Andrew Davidson, Andreas Schibler

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: Hypoxaemia during anaesthesia for tubeless upper airway surgery in children with abnormal airways is common due to the complexity of balancing adequate depth of anaesthesia with maintenance of spontaneous breathing and providing an uninterrupted field of view of the upper airway for the surgeon. High-flow nasal oxygenation (HIGH-FLOW) can prolong safe apnoea time and be used in children with abnormal airways but to date has not been compared with the alternative technique of low-flow nasal oxygenation (LOW-FLOW). The aim is to investigate if use of HIGH-FLOW can reduce the number of hypoxaemic events requiring rescue oxygenation compared with LOW-FLOW. METHODS AND ANALYSIS: High-flow oxygen for children's airway surgery: randomised controlled trial (HAMSTER) is a multicentre, unmasked, randomised controlled, parallel group, superiority trial comparing two oxygenation techniques during anaesthesia. Children (n=530) aged >37 weeks to 16 years presenting for elective tubeless upper airway surgery who fulfil inclusion but not exclusion criteria will be randomised prior to surgery to HIGH-FLOW or LOW-FLOW post induction of anaesthesia. Maintenance of anaesthesia with HIGH-FLOW requires Total IntraVenous Anaesthesia (TIVA) and with LOW-FLOW, either inhalational or TIVA at discretion of anaesthetist. The primary outcome is the incidence of hypoxaemic events requiring interruption of procedure for rescue oxygenation by positive pressure ventilation and the secondary outcome includes total hypoxaemia time, adverse cardiorespiratory events and unexpected paediatric intensive care admission admission. Hypoxaemia is defined as Sp02 <90%. Analysis will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION: Ethical approval has been obtained by Children's Health Queensland Human Research Ethics Committee (HREC/18/QRCH/130). The trial commenced recruitment in 2018. The primary manuscript will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: The HAMSTER is registered with the Australia and New Zealand Clinical TrialsRegistry: ACTRN12618000949280.

Original languageEnglish
Pages (from-to)e031873
JournalBMJ Open
Volume9
Issue number10
DOIs
Publication statusPublished - 14 Oct 2019

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Clinical Protocols
Anesthesia
Randomized Controlled Trials
Oxygen
Intravenous Anesthesia
Nose
Maintenance
Queensland
Positive-Pressure Respiration
Manuscripts
Research Ethics Committees
Apnea
Critical Care
New Zealand
Publications
Respiration
Pediatrics
Incidence
Hypoxia

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Humphreys, Susan ; von Ungern-Sternberg, Britta Sylvia ; Skowno, Justin ; Williams, Tara ; Taylor, Julia ; Taverner, Fiona ; Gibbons, Kristen ; Burgoyne, Laura ; Sommerfield, David ; Stephens, Philip ; Hallett, Ben ; Vijayasekaran, Shyan ; Slee, Nicola ; Burns, Hannah ; Sowa, Marcin ; Davidson, Andrew ; Schibler, Andreas. / High-flow oxygen for children's airway surgery : randomised controlled trial protocol (HAMSTER). In: BMJ Open. 2019 ; Vol. 9, No. 10. pp. e031873.
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Humphreys, S, von Ungern-Sternberg, BS, Skowno, J, Williams, T, Taylor, J, Taverner, F, Gibbons, K, Burgoyne, L, Sommerfield, D, Stephens, P, Hallett, B, Vijayasekaran, S, Slee, N, Burns, H, Sowa, M, Davidson, A & Schibler, A 2019, 'High-flow oxygen for children's airway surgery: randomised controlled trial protocol (HAMSTER)' BMJ Open, vol. 9, no. 10, pp. e031873. https://doi.org/10.1136/bmjopen-2019-031873

High-flow oxygen for children's airway surgery : randomised controlled trial protocol (HAMSTER). / Humphreys, Susan; von Ungern-Sternberg, Britta Sylvia; Skowno, Justin; Williams, Tara; Taylor, Julia; Taverner, Fiona; Gibbons, Kristen; Burgoyne, Laura; Sommerfield, David; Stephens, Philip; Hallett, Ben; Vijayasekaran, Shyan; Slee, Nicola; Burns, Hannah; Sowa, Marcin; Davidson, Andrew; Schibler, Andreas.

In: BMJ Open, Vol. 9, No. 10, 14.10.2019, p. e031873.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High-flow oxygen for children's airway surgery

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AU - Humphreys, Susan

AU - von Ungern-Sternberg, Britta Sylvia

AU - Skowno, Justin

AU - Williams, Tara

AU - Taylor, Julia

AU - Taverner, Fiona

AU - Gibbons, Kristen

AU - Burgoyne, Laura

AU - Sommerfield, David

AU - Stephens, Philip

AU - Hallett, Ben

AU - Vijayasekaran, Shyan

AU - Slee, Nicola

AU - Burns, Hannah

AU - Sowa, Marcin

AU - Davidson, Andrew

AU - Schibler, Andreas

PY - 2019/10/14

Y1 - 2019/10/14

N2 - INTRODUCTION: Hypoxaemia during anaesthesia for tubeless upper airway surgery in children with abnormal airways is common due to the complexity of balancing adequate depth of anaesthesia with maintenance of spontaneous breathing and providing an uninterrupted field of view of the upper airway for the surgeon. High-flow nasal oxygenation (HIGH-FLOW) can prolong safe apnoea time and be used in children with abnormal airways but to date has not been compared with the alternative technique of low-flow nasal oxygenation (LOW-FLOW). The aim is to investigate if use of HIGH-FLOW can reduce the number of hypoxaemic events requiring rescue oxygenation compared with LOW-FLOW. METHODS AND ANALYSIS: High-flow oxygen for children's airway surgery: randomised controlled trial (HAMSTER) is a multicentre, unmasked, randomised controlled, parallel group, superiority trial comparing two oxygenation techniques during anaesthesia. Children (n=530) aged >37 weeks to 16 years presenting for elective tubeless upper airway surgery who fulfil inclusion but not exclusion criteria will be randomised prior to surgery to HIGH-FLOW or LOW-FLOW post induction of anaesthesia. Maintenance of anaesthesia with HIGH-FLOW requires Total IntraVenous Anaesthesia (TIVA) and with LOW-FLOW, either inhalational or TIVA at discretion of anaesthetist. The primary outcome is the incidence of hypoxaemic events requiring interruption of procedure for rescue oxygenation by positive pressure ventilation and the secondary outcome includes total hypoxaemia time, adverse cardiorespiratory events and unexpected paediatric intensive care admission admission. Hypoxaemia is defined as Sp02 <90%. Analysis will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION: Ethical approval has been obtained by Children's Health Queensland Human Research Ethics Committee (HREC/18/QRCH/130). The trial commenced recruitment in 2018. The primary manuscript will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: The HAMSTER is registered with the Australia and New Zealand Clinical TrialsRegistry: ACTRN12618000949280.

AB - INTRODUCTION: Hypoxaemia during anaesthesia for tubeless upper airway surgery in children with abnormal airways is common due to the complexity of balancing adequate depth of anaesthesia with maintenance of spontaneous breathing and providing an uninterrupted field of view of the upper airway for the surgeon. High-flow nasal oxygenation (HIGH-FLOW) can prolong safe apnoea time and be used in children with abnormal airways but to date has not been compared with the alternative technique of low-flow nasal oxygenation (LOW-FLOW). The aim is to investigate if use of HIGH-FLOW can reduce the number of hypoxaemic events requiring rescue oxygenation compared with LOW-FLOW. METHODS AND ANALYSIS: High-flow oxygen for children's airway surgery: randomised controlled trial (HAMSTER) is a multicentre, unmasked, randomised controlled, parallel group, superiority trial comparing two oxygenation techniques during anaesthesia. Children (n=530) aged >37 weeks to 16 years presenting for elective tubeless upper airway surgery who fulfil inclusion but not exclusion criteria will be randomised prior to surgery to HIGH-FLOW or LOW-FLOW post induction of anaesthesia. Maintenance of anaesthesia with HIGH-FLOW requires Total IntraVenous Anaesthesia (TIVA) and with LOW-FLOW, either inhalational or TIVA at discretion of anaesthetist. The primary outcome is the incidence of hypoxaemic events requiring interruption of procedure for rescue oxygenation by positive pressure ventilation and the secondary outcome includes total hypoxaemia time, adverse cardiorespiratory events and unexpected paediatric intensive care admission admission. Hypoxaemia is defined as Sp02 <90%. Analysis will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION: Ethical approval has been obtained by Children's Health Queensland Human Research Ethics Committee (HREC/18/QRCH/130). The trial commenced recruitment in 2018. The primary manuscript will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: The HAMSTER is registered with the Australia and New Zealand Clinical TrialsRegistry: ACTRN12618000949280.

KW - abnormal airway

KW - anaesthesia

KW - children

KW - high-flow

KW - hypoxaemia

KW - paediatric

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