Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) ventilation during electroconvulsive therapy (ECT) for a pregnant patient– A novel technique

Vaithialingam, Balaji; Bansal, Sonia; Ramesh, VJ; Radhakrishnan, M.

doi:10.1016/j.ajp.2022.103023

Cited by 4 publications

(5 citation statements)

References 7 publications

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“…This reduces nasopharyngeal dead space, improves airway mucosal clearance function, and to some extent, has the effect of opening alveoli and promoting ventilation [ 30 ]. 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 ].…”

Section: Discussionmentioning

confidence: 99%

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

Zheng,

Yao,

Luo

et al. 2024

PLoS ONE

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Purpose To further identify the effectiveness of trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) for pre- and apneic oxygenation during the anesthesia induction by comparison to facemask ventilation (FMV) based on current available evidence. Methods Medline, EMBASE, Web of Science, Cochrane Library and CNKI databases were searched from inception to December 22, 2023 for available randomized controlled trials (RCTs). Primary outcomes were PaO2 and PaCO2 after intubation and safe apnoea time. Secondary outcomes included the O2 desaturation, end expiratory carbon dioxide (EtCO2) and complications. The effect measures for continuous and categorical outcomes were separately the mean difference (MD) and relative risk (RR) with 95% confidence interval. Results Twelve RCTs with 403 patients in the THRIVE group and 401 patients in th FMV group were included. Pooled results demonstrated that the PaO2 after intubation was significantly higher (MD = 82.90mmHg, 95% CI: 12.25~153.54mmHg, P = 0.02) and safe apnoea time (MD = 103.81s, 95% CI: 42.07~165.56s, P = 0.001) was longer in the THRIVE group. Besides, the incidence rate of O2 desaturation (RR = 0.28, 95% CI: 0.12–0.66, P = 0.004) and gastric insufflation (RR = 0.26, 95% CI: 0.13–0.49, P<0.001) was significantly lower in the THRIVE group. Conclusion Based on current evidence, THRIVE manifested better effectiveness representing as improved oxygenation, prolonged safe apnoea time and decreased risk of complications compared to standard FMV in surgical patients. Therefore, THRIVE could be served as a novel and valuable oxygenation technology for patients during anesthesia induction.

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Section: Discussionmentioning

confidence: 99%

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

Zheng,

Yao,

Luo

et al. 2024

PLoS ONE

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“…Several reports have described the usefulness of THRIVE in ECT [ 5 , 17 , 18 ]. Jonker et al performed 20 sessions of ECT with THRIVE on 13 patients and observed no desaturation or patient discomfort during the procedure [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…This involved the usage of a cervical collar, which simultaneously provides jaw thrust and cervical spine control in the THRIVE group since the effectiveness of THRIVE depends on the patient having a patent upper airway. The study reported an incidence of 0.5% desaturation with THRIVE, which proves its effectiveness in maintaining oxygenation in patients undergoing ECT while wearing a cervical collar [ 18 ]. In these reports, preoxygenation was performed at 30 L/min of oxygen, then increased to 50-70 L/min during induction of anesthesia and maintained throughout the procedure.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Oxygen Desaturation in a Patient With Previous Experience of Severe Hypoxia in Modified Electroconvulsive Therapy by Transnasal Humidified Rapid-Insufflation Ventilator Exchange: A Case Report

Toyota,

Kondo,

Narasaki

et al. 2024

Cureus

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Transnasal humidified rapid-insufflation ventilator exchange (THRIVE) has been reported to have better efficacy during anesthesia induction compared to conventional mask ventilation, including improved oxygenation and prolonged safe apnea time. This study reports on the effectiveness of the THRIVE system during modified electroconvulsive therapy (mECT) for a patient experiencing severe hypoxia. A 78-year-old female patient with bipolar disorder received maintenance mECT every four weeks. She previously experienced a significant hypoxic event, with oxygen saturation (SpO 2 ) dropping to 50% following electrical stimulation. In response, we employed the THRIVE system, designed to deliver high-flow, 100% oxygen, thereby extending apnea tolerance. The implementation of THRIVE ensured a stable oxygen supply, maintaining oxygen saturation levels above 95% throughout the mECT procedure. THRIVE is useful for treating hypoxia that occurs due to the unavoidable lack of ventilation during mECT.

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“…Thus, THRIVE can be beneficial during ECT, especially in pregnant patients, morbidly obese patients, and those at increased aspiration risk as there is no gastric insufflation that is seen with the conventional bag and mask technique. [ 13 ] The patients are pre-oxygenated with a THRIVE flow of 30 L/min through a custom-built nasal cannula [ Figure 4 ] that can be escalated to 50–70 L/min following the administration of short-acting intravenous anesthetic agents and muscle relaxants.…”

Section: Electroconvulsive Therapy and Thrivementioning

confidence: 99%

Trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) in neuroanesthesia practice: A review

Vaithialingam

Sriganesh

2023

Journal of Anaesthesiology Clinical Pharmacology

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Respiratory management is an important aspect of care in neuroanesthesia practice for neurosurgical patients. A wide variety of procedures are performed under sedation in the neurosurgical population, and maintaining oxygenation is of paramount importance during these procedures. The high-flow oxygen devices improve arterial oxygenation by providing higher inspiratory oxygen concentration and maintaining higher dynamic positive airway pressure. These devices have gained importance during the recent years with regard to enhancing patient safety. This narrative review focuses on the role of trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) and high-flow nasal oxygenation (HFNO) techniques in the neuroanesthesia practice and electroconvulsive therapy.

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Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) ventilation during electroconvulsive therapy (ECT) for a pregnant patient– A novel technique

Cited by 4 publications

References 7 publications

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

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

Prevention of Oxygen Desaturation in a Patient With Previous Experience of Severe Hypoxia in Modified Electroconvulsive Therapy by Transnasal Humidified Rapid-Insufflation Ventilator Exchange: A Case Report

Trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) in neuroanesthesia practice: A review

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