Prospective Evaluation of the Safety and Efficacy of THRIVE for Children Undergoing Airway Evaluation

Abstract

Background: Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) is a humidified high-flow nasal cannula capable of extending apneic time. Although THRIVE is assumed to stent upper airway soft tissues, this has not been objectively evaluated. Also, there are no prior studies providing safety and efficacy data for those patients undergoing upper airway evaluation using THRIVE. Methods: This report is a prospective study of the safety and efficacy of THRIVE in pediatric patients younger than 18 years old undergoing drug-induced sleep endoscopy. We positioned a flexible laryngoscope to view the larynx, and photographs were taken with no THRIVE flow (control) and with THRIVE flow at 10 and 20 liters per minute (LPM). Upper airway patency was measured using epiglottis to posterior pharynx distance, laryngeal inlet area, and modified Cormack–Lehane score at the trialed parameters. Vomiting and aspiration were our primary safety endpoints. Results: Eleven patients (6 women) with a mean age of 5.3 ± 2.1 years (2–8 years; SD, 2.05) were enrolled. Measurements of upper airway patency showed a significant THRIVE flow–associated increase in epiglottis to posterior pharynx distance (105 ± 54 at 10 L/min and 199 ± 67 at 20 L/min; P = 0.007) and nonsignificant increase of laryngeal inlet area (206 ± 148 at 10 L/min and 361 ± 190 at 20 L/min; P = 0.07). Cormack–Lehane score improved significantly at higher THRIVE volumes ( P = 0.006). Conclusions: THRIVE appears to safely improve upper airway patency during sleep endoscopy in the pediatric patient. In this study, we objectively document the flow-dependent increase in laryngeal patency associated with THRIVE.

Comparison of two different flexible laryngeal airway masks in pediatric ophthalmic surgeries: A retrospective study

“…After insertion, the ventilation tube can easily conform to the anatomic radian of the oropharynx and does not cause the ventilation tube to disintegrate, which is more conducive to maintaining good airway sealing pressure. [14–18]…”

“…After insertion, the ventilation tube can easily conform to the anatomic radian of the oropharynx and does not cause the ventilation tube to disintegrate, which is more conducive to maintaining good airway sealing pressure. [14][15][16][17][18] A high proportion of Medis laryngeal mask needs index finger guidance to be inserted, which is because the ventilation tube is very soft and the force is difficult to extend the ventilation tube downward. Because the laryngeal mask operator in the present study is skilled at the main point of the flexible laryngeal mask, although the laryngeal mask of the 2 groups did not show any obvious differences in quantity and time of insertion.…”

Anesthesia for Triple Endoscopy in Aerodigestive Patients

“…Higher flows can lead to the drying of the nasal mucosa and an increased potential for bleeding. As an alternative, a high-flow nasal cannula (HFNC) such as transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) can deliver up to 100% humidified and heated oxygen at a flow rate of up to 60 l per minute and has been shown to extend the apneic time and improve upper airway patency in pediatric patients undergoing sleep endoscopy [12,13].…”