SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management of the obstructed airway: an observational study

Abstract

Background. High-flow nasal oxygen (HFNO) has been shown to benefit oxygenation, ventilation and upper airway patency in a range of clinical scenarios, however its use in spontaneously breathing patients during general anaesthesia has not been described. Spontaneous respiration using i.v. anaesthesia is the primary technique used at our institution for tubeless airway surgery. We hypothesized that the addition of HFNO would increase our margin of safety, particularly during management of an obstructed airway. Methods. A retrospective observational study was conducted using a SponTaneous Respiration using IntraVEnous anaesthesia and High-flow nasal oxygen (STRIVE Hi) technique to manage 30 adult patients undergoing elective laryngotracheal surgery. Results. Twenty-six patients (87%) presented with significant airway and/or respiratory compromise (16 were stridulous, 10 were dyspnoeic). No episodes of apnoea or complete airway obstruction occurred during the induction of anaesthesia using STRIVE Hi. The median [IQR (range)] lowest oxygen saturation during the induction period was 100 [99–100 (97–100)] %. The median [IQR (range)] overall duration of spontaneous ventilation was 44 [40–49.5 (18–100)] min. The median [IQR (range)] end-tidal carbon dioxide (ETCO2) level at the end of the spontaneous ventilation period was 6.8 [6.4–7.1 (4.8–8.9)] kPa. The mean rate of increase in ETCO2 was 0.03 kPa min−1. Conclusions. STRIVE Hi succeeded in preserving adequate oxygen saturation, end-tidal carbon dioxide and airway patency. We suggest that the upper and lower airway benefits attributed to HFNO, are ideally suited to a spontaneous respiration induction, increasing its margin of safety. STRIVE Hi is a modern alternative to the traditional inhalation induction.

Predictors for failure of supraglottic superimposed high‐frequency jet ventilation during upper airway surgery in adult patients; a retrospective cohort study of 224 cases

“…An eventual conversion to endotracheal intubation does not jeopardise patient safety if the team is properly prepared. Previous studies focused on the safety, feasibility, limitations, complications of this technique, and analysis of CO 2 ‐elimination and gas‐exchange during SSHFJV and not on factors that may influence the success of SSHFJV …”

“…A “tubeless” HFJV method has been introduced in the late 90s: supraglottic superimposed HFJV (SSHFJV) . Other, frequently used tubeless technique is spontaneous breathing with propofol‐remifentanil anaesthesia with or without high‐flow nasal oxygenation . During SSHFJV, surgery is performed through a laryngoscope which has integrated jet stream nozzles enabling ventilation and no catheter is needed, in contrast to conventional HFJV.…”

“…1 Other, frequently used tubeless technique is spontaneous breathing with propofol-remifentanil anaesthesia with or without high-flow nasal oxygenation. 2,3 During SSHFJV, surgery is performed through a laryngoscope which has integrated jet stream nozzles enabling ventilation and no catheter is needed, in contrast to conventional HFJV. Using SSHFJV, there is completely free access of the surgical field and adequate oxygenation and ventilation can be achieved during surgery.…”

Nasal high‐flow oxygen in pediatric anesthesia and airway management

“…In adult anesthesia, both the use of NHF during spontaneous breathing and THRIVE in paralyzed patients have been successfully described as the oxygenation technique to allow an unobstructed view during abnormal airway procedures and a prolonged safe apnea time, most commonly using flows of 50‐70 L/min . NHF during pediatric upper airway surgery has experienced a rapid uptake recently without robust evidence but some convincing case series show promising results.…”

A strategy for securing a definitive airway after successful rescue by supraglottic airway device: TABASCO

“…13 Booth et al also share the opinion that in some cases spontaneous breathing will be superior to positive pressure, having commented on our article. 3,14 As they point out, if the airway can be successfully managed by using a SAD, one can facilitate intubation through it while upholding spontaneous ventilation, at the same time avoiding excessive anesthetics or neuromuscular blocking drugs (NMBD). We agree that, if possible, this can be a feasible solution.…”