Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) augments oxygenation in children with cyanotic heart disease during microdirect laryngoscopy and bronchoscopy

Caruso, Thomas J.; Sidell, Douglas; Lennig, Michael; Menéndez, María; Fonseca, Ahtziri; Rodríguez, Samuel; Tsui, Ban C. H.

doi:10.1016/j.jclinane.2019.01.029

Cited by 7 publications

(5 citation statements)

References 5 publications

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“…9,10 Humphreys et al 18 performed a proof-of-concept study on 48 healthy children of different age groups and demonstrated that the use of THRIVE is feasible for extending the apneic times in pediatric patients. This result was confirmed by Riva et al 17 Consistent with previous studies, [18][19][20][21][22] we found that younger children desaturated faster and had a significantly lower minimum Spo 2 during apnea without oxygen supplementation than older children. 30 The safe apnea time without THRIVE in children with JORRP resembled that of healthy children in Humphreys' study.…”

Section: Discussionsupporting

confidence: 92%

“…[17][18][19] Several small prospective observational trials, retrospective reviews, and case reports have reported on oxygenation with THRIVE during tubeless laryngeal surgery. [20][21][22] Those studies offered the promise that THRIVE could also extend the apnea time in JORRP patients; however, there was no empirical evidence of this. There is a lack of randomized clinical trails on the efficacy of THRIVE in children with difficult airways in the setting of tubeless laryngeal surgery.…”

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confidence: 99%

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Transnasal Humidified Rapid Insufflation Ventilatory Exchange Augments Oxygenation in Children With Juvenile Onset Recurrent Respiratory Papillomatosis During Surgery: A Prospective Randomized Crossover Controlled Trial

Lei

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Evidence is lacking regarding the efficacy of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) in tubeless anesthesia, especially in pediatric patients. This study aimed to evaluate the use of THRIVE for juvenile onset recurrent respiratory papillomatosis (JORRP) patients. METHODS: Twenty-eight children aged 2 to 12 years with JORRP, abnormal airways, and ASA physical status II–III that presented for surgical treatment under general anesthesia were included in this study. Each patient received 2 interventions in random order, with a 5-minute washout period between treatments: apnea without oxygen supplementation and apnea with THRIVE intervention. The primary outcome apnea time was defined as the duration from withdrawal of intubation to reintubation and resumption of controlled ventilation. The secondary outcomes were the mean transcutaneous carbon dioxide (tcco 2) increase rate, the minimum pulse oxygen saturation (Spo 2) during apnea, and the occurrence of unexpected adverse effects. RESULTS: The median apnea time in the THRIVE period was significantly longer than that in the control period (8.9 [8.6–9.4] vs 3.8 [3.4–4.3] minutes; mean difference [95% confidence interval (CI)], 5.0 [4.4–5.6]; P < .001) for all patients. The rate of CO2 change in the control period was higher than that in the THRIVE period both for patients aged 2 to 5 years old (6.29 [5.19–7.4] vs 3.22 [2.92–3.76] mm Hg min−1; mean difference [95% CI], 3.09 [2.27–3.67]; P < .001) and for patients aged 6 to 12 years old (4.76 [3.7–6.2] vs 3.38 [2.64–4.0] mm Hg min−1; mean difference [95% CI], 1.63 [0.75–2.56]; P < .001). The minimum Spo 2 was significantly higher in the THRIVE period than in the control period (mean difference [95% CI], 19.7 [14.8–22.6]; P < .001). CONCLUSIONS: Our findings demonstrate that THRIVE safely increased the apnea time among children with JORRP undergoing surgery and decreased the rate of carbon dioxide increase. THRIVE is clinically recommended as an airway management technique for tubeless anesthesia in apneic children.

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

Transnasal Humidified Rapid Insufflation Ventilatory Exchange Augments Oxygenation in Children With Juvenile Onset Recurrent Respiratory Papillomatosis During Surgery: A Prospective Randomized Crossover Controlled Trial

Lei

et al. 2023

Anesthesia &Amp; Analgesia

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“…Another critical issue regarding anesthesia for IB is to maintain oxygenation with the necessity for an airway free of endotracheal tubes required for satisfactory IB procedural fields. As high-flow nasal oxygen (HFNO) has been applied successfully to maintain oxygenation on bronchoscopy [11,12] and other laryngeal surgery without endotracheal intubations, [13][14][15] it may be helpful on maintaining oxygenation with non-intubated IB (NIIB). When immobilization is necessary, apneic ventilation could also be performed with HFNO [16] for NIIB.…”

Section: Observational Studymentioning

confidence: 99%

Nonintubated bronchoscopic interventions with high-flow nasal oxygen

et al. 2022

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To determine the feasibility on maintaining oxygenation of high-flow nasal oxygenation (HFNO) with bispectral index-guided intravenous anesthesia for nonintubated interventional bronchoscopy (NIIB). If desaturation happens, the factors influencing intraprocedural desaturation were also analyzed.This is a single-center retrospective study on patients receiving NIIB with HFNO and intravenous anesthesia guided by bispectral index levels to the depth of general anesthesia, which were between 40 and 60. Intraprocedural desaturation (SPO 2 < 90%) and complications (bleeding, delayed discharge, unexpected admission) were collected. Factors affecting desaturation and complications were analyzed including patients' factors (age, American Society of Anesthesiologists classification, body mass index [BMI]), procedural factors (procedural time, with or without use of cryoprobe), and setting (outpatient or hospitalized).Records of 223 patients receiving NIIB were collected. The NIIB procedures time was 56.1 ± 26.8 minute. Sixty patients (26.9%) presented desaturation events. Higher BMI, but not procedure time or setting, was significantly associated with desaturation. The desaturation were resolved after relieving upper airway obstruction but 1 patient required bag-valve-mask ventilation to restore oxygenation. Accidental massive bleeding and intraprocedural desaturation during tracheal and bronchial recannulation with cryoprobes happened in 2 patients and 1 of them was admitted to intensive care unit.HFNO is feasible to maintain oxygenation during NIIB only if there is effective upper airway management especially for patients with higher BMI. Longer procedural time and different setting did not affect the desaturation rate. Complications and unexpected admission were associated with the use of cryoprobes.Abbreviations: ASA = American Society of Anesthesiologists, BIS = bispectral index, BMI = body mass index, HFNO = highflow nasal oxygenation, IB = interventional bronchoscopy, NIIB = nonintubated interventional bronchoscopy, PACU = postanesthesia care unit, TBC = transbronchial cryobiopsy.

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“…In the presence of apnea and a patent upper airway, oxygen saturations can be maintained using high‐flow, humidified oxygen delivery equipment, such as the THRIVE system . This has been described in adults, the morbidly obese, children, and infants with and without congenital heart disease . Anesthesia must be maintained through a total intravenous technique, and muscle relaxation can optimize surgical access and conditions.…”

Section: Anesthetic Techniquesmentioning

confidence: 99%

Anesthesia for shared airway surgery in children

Bradley

Lee

Peyton

2020

Pediatric Anesthesia

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Shared airway surgery in children is a complex, high‐risk undertaking that requires continuous communication and cooperation between the anesthetic and surgical teams. Airway abnormalities commonly seen in children, the surgical options, and the anesthetic techniques that can be used to care for this vulnerable population are discussed. Many of these procedures were traditionally carried out using jet ventilation, or intermittent tracheal intubation, but increasingly spontaneously breathing “tubeless” techniques are being used. This review has been written from both the surgical and anesthetic perspective, highlighting the concerns that both specialties have in relation to the maintenance of surgical access and operating conditions, and the need for the provision of anesthesia, oxygenation, and ventilation where the airway is the primary site of operation.

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Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) augments oxygenation in children with cyanotic heart disease during microdirect laryngoscopy and bronchoscopy

Cited by 7 publications

References 5 publications

Transnasal Humidified Rapid Insufflation Ventilatory Exchange Augments Oxygenation in Children With Juvenile Onset Recurrent Respiratory Papillomatosis During Surgery: A Prospective Randomized Crossover Controlled Trial

Transnasal Humidified Rapid Insufflation Ventilatory Exchange Augments Oxygenation in Children With Juvenile Onset Recurrent Respiratory Papillomatosis During Surgery: A Prospective Randomized Crossover Controlled Trial

Nonintubated bronchoscopic interventions with high-flow nasal oxygen

Anesthesia for shared airway surgery in children

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