Utility of Transnasal Humidified Rapid Insufflation Ventilatory Exchange for Microlaryngeal Surgery
Utility of Transnasal Humidified Rapid Insufflation Ventilatory Exchange for Microlaryngeal Surgery
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DOI：
10.1002/lary.28776
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发表时间：
2020-06-16
期刊：
影响因子：
2.6
通讯作者：
Bryson, Paul C.
中科院分区：
文献类型：
--
作者：
Benninger, Michael S.;Zhang, Emily S.;Bryson, Paul C.
目的微喉手术通常需要通过气管内插管（ETT）、喷射通气（JV）或间歇呼吸暂停（ETT）进行氧合和通气。经鼻湿化快速充气通气交换（THRIVE）是一种由高流量鼻插管提供的替代技术。这种无氧氧合和通气方法可以稳定、通畅地观察不能动的喉部结构。我们的目的是描述技术和表征术中参数相关的安全性。研究设计案例系列。方法对采用THRIVE技术行喉镜检查的患者的电子病历进行回顾性分析。回顾了患者的人口统计、手术细节、手术参数和麻醉记录。进行描述性统计。结果53例患者采用THRIVE作为唯一通气方式行喉镜检查，其中女性占62%。中位年龄为51岁，中位BMI为25 kg/m(2)。大多数患者为ASA 2级，大多数患者的Mallampati评分为2。最常见的手术指征是声门下狭窄、声带病变和声带麻痹。中位呼吸暂停时间为16分钟。病例结束时，中位末潮CO(2)为50 mmHg，中位最小SpO(2)为95。6例患者需要在JV或气管插管的情况下补充THRIVE来维持持续的氧饱和度。呼吸暂停时间末潮CO(2)增加0.844 mmHg/min。结论THRIVE是一种安全有效的微创非激光手术氧合通气技术。为了确保安全，应该有备用计划，如喷射通风和微喉ETT。证据水平4喉镜，2020
Objective Microlaryngeal surgery typically requires oxygenation and ventilation via either an endotracheal tube (ETT), jet ventilation (JV), or intermittent apnea with an ETT. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) delivered by high flow nasal cannula has been reported as an alternative technique. This method of apneic oxygenation and ventilation allows for stable, unobstructed visualization of immobile laryngeal structures. We aim to describe the technique and characterize intraoperative parameters related to its safety. Study Design Case Series. Methods The electronic medical record was reviewed for patients who underwent microlaryngoscopy using THRIVE technique. Patient demographics, procedural details, operative parameters, and anesthesia records were reviewed. Descriptive statistics were reported. Results A total of 53 patients underwent microlaryngoscopy using THRIVE as the sole method of ventilation, with 62% female. Median age was 51 years, and median BMI was 25 kg/m(2). Most patients were ASA class 2, and most had a Mallampati score of 2. The most common surgical indications were subglottic stenosis, vocal fold lesions, and vocal fold paralysis. Median apnea time was 16 minutes. At the end of case, median end tidal CO(2)was 50 mmHg, and median minimum SpO(2)was 95. Six cases required supplementation of THRIVE with JV or tracheal intubation for sustained oxygen desaturation. There was an increase in end tidal CO(2)of 0.844 mmHg/min of apneic time. Conclusions THRIVE is a safe and effective technique for oxygenation and ventilation in microlaryngeal, non-laser surgery in appropriately selected patients. To ensure safety, back-up plans such as jet ventilation and microlaryngeal ETT should be available. Level of Evidence 4Laryngoscope, 2020