{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T15:30:33Z","timestamp":1789831833275,"version":"4.0.1"},"reference-count":48,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T00:00:00Z","timestamp":1550188800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Clinical observations suggest that compared with standard apnoeic oxygenation, transnasal humidified rapid\u2010insufflation ventilatory exchange using high\u2010flow nasal oxygenation reduces the rate of carbon dioxide accumulation in patients who are anaesthetised and apnoeic. This suggests that active gas exchange takes place, but the mechanisms by which it may occur have not been described. We used three laboratory airway models to investigate mechanisms of carbon dioxide clearance in apnoeic patients. We determined flow patterns using particle image velocimetry in a two\u2010dimensional model using particle\u2010seeded fluorescent solution; visualised gas clearance in a three\u2010dimensional printed trachea model in air; and measured intra\u2010tracheal turbulence levels and carbon dioxide clearance rates using a three\u2010dimensional printed model in air mounted on a lung simulator. Cardiogenic oscillations were simulated in all experiments. The visualisation experiments indicated that gaseous mixing was occurring in the trachea. With no cardiogenic oscillations applied, mean (\n                    <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>\n                    ) carbon dioxide clearance increased from 0.29 (0.04) ml.min\n                    <jats:sup>\u22121<\/jats:sup>\n                    to 1.34 (0.14) ml.min\n                    <jats:sup>\u22121<\/jats:sup>\n                    as the transnasal humidified rapid\u2010insufflation ventilatory exchange flow rate was increased from 20\u00a0l.min\n                    <jats:sup>\u22121<\/jats:sup>\n                    to 70\u00a0l.min\n                    <jats:sup>\u22121<\/jats:sup>\n                    (p\u00a0=\u00a00.0001). With a cardiogenic oscillation of 20\u00a0ml.beat\n                    <jats:sup>\u22121<\/jats:sup>\n                    applied, carbon dioxide clearance increased from 11.9 (0.50) ml.min\n                    <jats:sup>\u22121<\/jats:sup>\n                    to 17.4 (1.2) ml.min\n                    <jats:sup>\u22121<\/jats:sup>\n                    as the transnasal humidified rapid\u2010insufflation ventilatory exchange flow rate was increased from 20\u00a0l.min\n                    <jats:sup>\u22121<\/jats:sup>\n                    to 70\u00a0l.min\n                    <jats:sup>\u22121<\/jats:sup>\n                    (p\u00a0=\u00a00.0014). These findings suggest that enhanced carbon dioxide clearance observed under apnoeic conditions with transnasal humidified rapid\u2010insufflation ventilatory exchange, as compared with classical apnoeic oxygenation, may be explained by an interaction between entrained and highly turbulent supraglottic flow vortices created by high\u2010flow nasal oxygen and cardiogenic oscillations.\n                  <\/jats:p>","DOI":"10.1111\/anae.14541","type":"journal-article","created":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T04:46:04Z","timestamp":1550205964000},"page":"441-449","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":103,"title":["A physiological study to determine the mechanism of carbon dioxide clearance during apnoea when using transnasal humidified rapid insufflation ventilatory exchange (THRIVE)"],"prefix":"10.1111","volume":"74","author":[{"given":"L. A.","family":"Hermez","sequence":"first","affiliation":[{"name":"Anaesthesia Research Group Fisher and Paykel Healthcare Ltd Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. J.","family":"Spence","sequence":"additional","affiliation":[{"name":"Anaesthesia Research Group Fisher and Paykel Healthcare Ltd Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. J.","family":"Payton","sequence":"additional","affiliation":[{"name":"Anaesthesia Research Group Fisher and Paykel Healthcare Ltd Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. A. R.","family":"Nouraei","sequence":"additional","affiliation":[{"name":"Robert White Centre for Airway Voice and Swallowing Poole Hospital NHS Foundation Trust Poole UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Royal National Throat, Nose and Ear Hospital in UCLH London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. H.","family":"Barnes","sequence":"additional","affiliation":[{"name":"Anaesthesia Research Group Fisher and Paykel Healthcare Ltd Auckland New Zealand"},{"name":"Science and Technology Solutions Ltd Warlingham UK"},{"name":"University of Greenwich London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,2,15]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-017-1640-2"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04577"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0028-2017"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-016-0278-4"},{"key":"e_1_2_6_6_1","first-page":"E207","article-title":"High\u2010flow oxygen cannula: a very effective method to correct severe hypoxemia","volume":"7","author":"Vincent J\u2010L","year":"2015","journal-title":"Journal of Thoracic Disease"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.2711"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1503326"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12923"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-194709000-00009"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1959.14.1.97"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-195911000-00007"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aex036"},{"key":"e_1_2_6_14_1","unstructured":"HengenM BischoffG KoesslerS et\u00a0al.Changes in transcutaneous carbon dioxide tension during apneic oxygenation for suspension laryngoscopy. 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