Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) in Children requiring emergent intubation

Success and quality of emergency intubation is dependent on patient and operator factors. In experienced hands the time to successful intubation can be shorter and the likelihood of successful intubation greater. Since ideal conditions and high expertise cannot be guaranteed for all emergency intubations, the optimisation of patient and operator related factors are paramount.  To improve patient related factors, pre-oxygenation prior to induction of anaesthesia has been described since 1955 as a mechanism for maximising oxygen reserves and therefore prolonging the safe apnoeic time available for intubation in emergency and difficult intubations. Newer methods to continue improved oxygenation during the apnoeic phase have recently emerged.

This new delivery method using a Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) technique has been shown to prolong apnoeic oxygenation time in healthy adult and paediatric patients, thus enabling unhurried intubation in patients with expected difficult airways. This method allows continued post induction oxygen delivery during attempted intubation in those with known difficult anatomical airways and cardiorespiratory compromise.

The aim of this study is to assess the effect of Nasal High Flow (NHF) oxygen as a method for prolonging the safe apnoeic time during  emergent intubation of children to reduce the proportion adverse events (specifically, oxygen desaturation) and increase the proportion of first attempt success for endotracheal intubation. This study is a multicentre, non-blinded, randomised controlled trial evaluating the efficacy of NHF oxygen used for apnoeic oxygenation during emergency intubation of children.  Participants will be randomised to either NHF oxygen (THRIVE) or standard clinical practice during intubations. Blinding is not possible in this study given the nature of the proposed intervention. 

Study design

Multicentre, non-blinded, randomised controlled trial

Chief Investigator

Shane George (Gold Coast University Hospital)


2017 – 2020


  • Emergency Medicine Foundation
  • Thrasher Research Foundation

Site locations

  • Gold Coast University Hospital, Southport, QLD, Australia
  • Lady Cilento Children’s Hospital, Brisbane, QLD, Australia
  • Townsville Hospital
  • Starship Children’s Hospital
  • Royal Children’s Hospital, Melbourne (PICU only)


820 intubations of children aged 0-16 years

Clinical trials registrations

To be confirmed