{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:22:30Z","timestamp":1784697750193,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High\u2010flow oxygen in children prolongs the apnea time. The exact mechanism remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study investigated whether low\u2010 and high\u2010flow nasal oxygen are non\u2010inferior to very high\u2010flow oxygen in preventing lung volume loss during apnoea in children under general anesthesia. We also examined whether early onset oxygen using the Optiflow Switch cannula reduces lung volume loss compared to conventional late\u2010onset application. Finally, we assessed the timing and regional distribution of lung volume changes using electrical impedance tomography (EIT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a single center randomized controlled non\u2010inferiority trial. After Ethics Committee approval and informed consent, we recruited 108 children (ASA1 and 2, 10\u201320\u2009kg) undergoing elective general anesthesia. The primary endpoint was the normalized reduction in lung volume in relation to body weight (mL\u2009kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      ) after termination of facemask ventilation from start to end of apnoea measured with EIT. After induction of anesthesia and neuromuscular blockade, patients were left apnoeic for 5\u2009min receiving humidified and heated oxygen with a high\u2010flow system at different flow rates: (1) Low\u2010flow 0.2\u2009L\u2009min\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u2009kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      ; (2) High\u2010flow 2\u2009L\u2009min\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u2009kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      ; (3) Very high\u2010flow 4\u2009L\u2009min\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u2009kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      (control group); (4) Early onset of high\u2010flow 2\u2009L\u2009min\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u2009kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      with Optiflow Switch. Normalization of impedance change to 6\u20138\u2009mL\u2009kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      in relation to body weight and changes in lung volume from start to end of apnoea were measured.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      89\/108 children were analyzed (low\u2010flow\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920, high\u2010flow\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924, very high\u2010flow\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200921 and early onset high\u2010flow\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924.). The estimated mean (95% CI) reduction in lung volume was: low\u2010flow 5.9 (5.3\u20137.8) mL\u2009kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      , high\u2010flow 6.5 (5.3\u20137.8) mL\u2009kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      , very high\u2010flow (control) 5.7 (4.4\u20137.0) mL\u2009kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      , and early onset high\u2010flow 6.7 (5.5\u20137.9) mL\u2009kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      . Non\u2010inferiority could be demonstrated only for the low\u2010flow group compared to the control group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Apnoeic oxygenation with low\u2010flow is non\u2010inferior to very high\u2010flow regarding lung volume loss in children. An early onset of apnoeic oxygenation after facemask ventilation may delay lung volume loss during apnoea.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pan.70018","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T13:06:59Z","timestamp":1752844019000},"page":"36-42","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Lung Volume Change Under Apnoeic Oxygenation With Different Flow Rates in Children: A Single\u2010Centre Prospective Randomized Controlled Non\u2010Inferiority Trial"],"prefix":"10.1111","volume":"36","author":[{"given":"Jonas","family":"Aebli","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Inselspital, Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Bohnenblust","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Inselspital, Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Koepp\u2010Medina","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Inselspital, Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Ahsani\u2010Nasab","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Inselspital, Bern University Hospital, University of Bern  Bern Switzerland"},{"name":"Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular and Public Health University of Padova  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Inselspital, Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Greif","sequence":"additional","affiliation":[{"name":"Medical Faculty University of Bern  Bern Switzerland"},{"name":"Department of Surgical Science University of Torino  Torino Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Disma","sequence":"additional","affiliation":[{"name":"Unit for Research in Anesthesia IRCCS Istituto Giannina Gaslini  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1297-3427","authenticated-orcid":false,"given":"Thomas","family":"Riva","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Inselspital, Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Riedel","sequence":"additional","affiliation":[{"name":"Division of Pediatric Intensive Care Medicine, Department of Pediatrics Bern University Hospital, Inselspital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Inselspital, Bern University Hospital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"e_1_2_10_2_1","article-title":"High\u2010Flow Nasal Cannula Therapy for Respiratory Support in Children","volume":"2014","author":"Mayfield S.","year":"2014","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000112"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.9615"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.3367"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000246813.04771.03"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16187"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.02.021"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.04.013"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03011582"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001384"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aew186"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aew401"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001189"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2023.10.039"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2017.12.017"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211828"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211879"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-013-2879-y"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04028"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15224"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0273120"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-208357"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1088\/0967-3334\/30\/6\/S03"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0188313"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-012-2469-7"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0106591"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1891.sp000394"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aew173"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000261503.29619.9c"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.70018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T06:24:51Z","timestamp":1765261491000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.70018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,18]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/pan.70018"],"URL":"https:\/\/doi.org\/10.1111\/pan.70018","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,18]]},"assertion":[{"value":"2025-02-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}