The use of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange in 17 cases of subglottic stenosis

To, Kim; Harding, Fleur; Scott, M P; Milligan, Pamela; Nixon, Iain J.; Adamson, Richard; McNarry, Alistair F.

doi:10.1111/coa.12921

Cited by 48 publications

(50 citation statements)

References 10 publications

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“…) . Other workers have also published results indicating that the rate of increase in carbon dioxide with THRIVE is lower than in classical apnoeic oxygenation .…”

Section: Discussionmentioning

confidence: 92%

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A physiological study to determine the mechanism of carbon dioxide clearance during apnoea when using transnasal humidified rapid insufflation ventilatory exchange (THRIVE)

et al. 2019

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Summary Clinical observations suggest that compared with standard apnoeic oxygenation, transnasal humidified rapid‐insufflation ventilatory exchange using high‐flow 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‐dimensional model using particle‐seeded fluorescent solution; visualised gas clearance in a three‐dimensional printed trachea model in air; and measured intra‐tracheal turbulence levels and carbon dioxide clearance rates using a three‐dimensional 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 (SD) carbon dioxide clearance increased from 0.29 (0.04) ml.min−1 to 1.34 (0.14) ml.min−1 as the transnasal humidified rapid‐insufflation ventilatory exchange flow rate was increased from 20 l.min−1 to 70 l.min−1 (p = 0.0001). With a cardiogenic oscillation of 20 ml.beat−1 applied, carbon dioxide clearance increased from 11.9 (0.50) ml.min−1 to 17.4 (1.2) ml.min−1 as the transnasal humidified rapid‐insufflation ventilatory exchange flow rate was increased from 20 l.min−1 to 70 l.min−1 (p = 0.0014). These findings suggest that enhanced carbon dioxide clearance observed under apnoeic conditions with transnasal humidified rapid‐insufflation 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‐flow nasal oxygen and cardiogenic oscillations.

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“…) . Other workers have also published results indicating that the rate of increase in carbon dioxide with THRIVE is lower than in classical apnoeic oxygenation .…”

Section: Discussionmentioning

confidence: 92%

“…They observed not only an extension of time until desaturation, but also a significantly lower rate of carbon dioxide accumulation than would have been expected with ‘classical’ apnoeic oxygenation . Further studies have also shown reduced accumulation of carbon dioxide .…”

Section: Introductionmentioning

confidence: 85%

A physiological study to determine the mechanism of carbon dioxide clearance during apnoea when using transnasal humidified rapid insufflation ventilatory exchange (THRIVE)

et al. 2019

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“…1 Whilst there have been several publications highlighting its benefit in various airway settings, 2-6 all have been relatively small. THRIVE has been available in our institution since 2015 and after success in patients with subglottic stenosis, 5 we now report its use in 105 cases.…”

Section: The Use Of Transnasal Humidified Rapid-insufflation Ventilatmentioning

confidence: 96%

The use of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) in one hundred and five upper airway endoscopies. A case series

Waters

Kellner

Milligan

et al. 2019

Clinical Otolaryngology

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“…Recently, apnoeic oxygenation with high‐flow nasal oxygen has enabled tubeless anaesthesia for extended periods, in excess of that which is achievable with low‐flow nasal oxygen and buccal oxygen administration (Fig. ) . A summary of relevant case series is included in the Supporting Information (Table S1).…”

Section: Tubeless Anaesthesiamentioning

confidence: 99%

“…The absence of a tracheal tube precludes intra‐operative end‐tidal carbon dioxide measurement. Some clinicians undertake arterial or venous blood gas analysis during the apnoeic period , whereas others await ET CO2 measurement on completion of surgery . Clinicians must exert caution in interpreting ET CO2 measurements as they underestimate the rate of carbon dioxide accumulation, and consequently, underestimate the degree of acidaemia .…”

Section: Tubeless Anaesthesiamentioning

confidence: 99%

Uses and mechanisms of apnoeic oxygenation: a narrative review

Lyons

Callaghan

2019

Anaesthesia

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Apnoeic oxygenation refers to oxygenation in the absence of spontaneous respiration or mechanical ventilation. It has been described in humans for over half a century and has seen a resurgence in interest given its potential to delay oxygen desaturation during airway management, especially with the advent of high-flow nasal cannulae. This narrative review summarises our current understanding of the mechanisms of gas exchange during apnoeic oxygenation and its diverse range of clinical applications, including its use at induction of anaesthesia and for the facilitation of 'tubeless anaesthesia'. Additional discussion covers use in critical care, obese, obstetric and paediatric sub-populations. The article also highlights current research efforts aiming to enhance the evidence base for the use of this technique.

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The use of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange in 17 cases of subglottic stenosis

Cited by 48 publications

References 10 publications

A physiological study to determine the mechanism of carbon dioxide clearance during apnoea when using transnasal humidified rapid insufflation ventilatory exchange (THRIVE)

A physiological study to determine the mechanism of carbon dioxide clearance during apnoea when using transnasal humidified rapid insufflation ventilatory exchange (THRIVE)

The use of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) in one hundred and five upper airway endoscopies. A case series

Uses and mechanisms of apnoeic oxygenation: a narrative review

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