The Safety and Efficacy of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange for Laryngologic Surgery

Abstract

Objectives: Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is an intraoperative ventilatory technique that allows avoidance of tracheal intubation (TI) or jet ventilation (JV) in selected laryngologic surgical cases. Unimpeded access to all parts of the glottis may improve surgical precision, decrease operative time, and potentially improve patient outcomes. The objective of this prospective, randomized, patient-blinded, 2-arm parallel pilot trial was to investigate the safety and efficacy of THRIVE use for adult patients undergoing nonlaser laryngologic surgery of short-to-intermediate duration. Methods: Twenty adult, American society of anesthesiology class 1-3 patients with body mass index (BMI) < 35 kg/m 2 were randomly assigned to either an experimental THRIVE group or active comparator conventional ventilation group (TI or supraglottic high-frequency JV [SHFJV]). Primary outcomes included intraoperative oxygenation, anesthesia awakening/ extubation time, time to laryngoscopic suspension, number of intraoperative suspension adjustments, and operative time. Secondary patient outcomes including postanesthesia and functional patient recovery were investigated. Results: Compared to TI/SHFJV, THRIVE use was associated with significantly lower intraoperative oxygenation (SpO 2 93.0 AE 5.6% vs. 98.7 AE 1.6%), shorter time to suspension (1.8 AE 1.1 minutes vs. 4.3 AE 2.1 minutes), fewer suspension adjustments (0.4 AE 0.5 vs. 1.7 AE 0.9), and lower postoperative pain scores on recovery room admission (1.3 AE 1.9 vs. 3.7 AE 2.9) and discharge (0.9 AE 1.3 vs. 2.7 AE 1.8). The study was underpowered to detect other possible outcome differences. Conclusion: We confirm the safe intraoperative oxygenation profile of THRIVE for selected patients undergoing nonlaser laryngologic surgery of short-to-intermediate duration. THRIVE facilitated surgical exposure and improved early patient recovery, suggesting a potential economic benefit for outpatient laryngologic procedures. The results of this exploratory study provide a framework for designing future adequately powered THRIVE trials. Trial Register: ClinicalTrials.gov (NCT03091179).

Application and Efficiency of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange in Laryngeal Microsurgery

“…A wider surgical view may provide a greater access to the lesion under THRIVE, expediting the surgical process and thereby improving the efficiency. A recent study demonstrated shorter time to suspension with fewer adjustments in the THRIVE group compared with the conventional intubation group, which tended to present shorter duration of surgery, although did not reach significance 28 . In our research, THRIVE was associated with significantly shorter operation time, which, combined with a shorter emergence time, resulted in a shorter anesthesia time.…”

Tubeless Anesthesia in Subglottic Stenosis: Comparative Review of Apneic Low‐Flow Oxygenation With THRIVE

“…6 The role of apneic oxygenation during anesthesia in patients with subglottic stenosis is still being explored. 3,[7][8][9][10][11][12][13] In particular, the rate of carbon dioxide accumulation rather than the level of oxygenation can limit its application. Carbon dioxide accumulation does occur with THRIVE but the rate is tempered indicating at least partial ventilation.…”

“…The role of apneic oxygenation during anesthesia in patients with subglottic stenosis is still being explored 3,7–13 . In particular, the rate of carbon dioxide accumulation rather than the level of oxygenation can limit its application.…”

Fire safety and emergency evacuation guidelines for intensive care units and operating theatres: for use in the event of fire, flood, power cut, oxygen supply failure, noxious gas, structural collapse or other critical incidents

“…Separating clinical and non-clinical areas [1,2,6] Door widths on bays and side rooms should be big enough to allow bariatric beds to pass through without adjustment [1,2,7] Automatic smoke control systems in ICU and consideration for low-level emergency lighting to assist with emergency evacuations Consideration of modern sprinkler and misting systems [6,20,29] Operating theatres should be arranged in zones so that > 50% of operating theatres remain unaffected by a fire should one occur, for example, an operating theatre complex of 8 theatres in a row can be divided into two blocks of four theatres, separated by a 30-min fire-rated sub-compartment…”