Addressing desaturation in a tracheal stenosis patient using the transnasal humidified rapid-insufflation ventilatory exchange technique during tracheostomy: A case report

Abstract

Rationale: Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is used in tracheostomy but not in cases of airway obstruction. This case report explores the use of THRIVE for managing airway obstruction during tracheostomy in patients with subglottic and tracheal stenosis, thereby addressing the current knowledge gap and exploring its potential for airway management. Patient concerns: A 63-year-old female with subglottic and tracheal stenoses underwent tracheostomy. Multiple attempts to establish a patent airway were unsuccessful, and oxygen saturation dropped to 56%. Diagnosis: Endotracheal tube was directed toward the tracheal wall, causing airway obstruction. Interventions: THRIVE was administered to the patient. Subsequently, the tube position was adjusted to enhance ventilation. Outcomes: The patient’s oxygen saturation increased to 99%. The postoperative complications, including subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumopericardium, resolved. The patient was discharged on postoperative day 9. Lessons: THRIVE could be considered a temporary measure to enhance oxygenation before initiating a definitive treatment strategy.

Effectiveness of trans-nasal humidified rapid insufflation ventilatory exchange compared with standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: A meta-analysis based on randomized controlled trials

“…Additionally, THRIVE can establish an O 2 pressure difference gradient between the upper airway and alveoli, as well as between alveoli and pulmonary capillaries, driving O 2 diffusion into the pulmonary capillaries, achieving the "apneic diffusive oxygenation" effect [ 31 ]. Currently, THRIVE is primarily used for respiratory support in patients with respiratory dysfunction to improve and treat hypercapnia or mild to moderate hypoxic respiratory failure [ 32 – 34 ]. However, its application in the field of anesthesia remains limited.…”