PDF(Pubmed)
Abstract：
UNASSIGNED: Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) describes apneic oxygenation using humidified high flow nasal-cannula oxygen. Although it has been described as a sole mode of oxygenation in endoscopic laryngotracheal surgery, its use in endoscopic esophageal surgery under general anesthesia with neuromuscular paralysis has not previously been described. The objective of this study is to assess the safety and efficacy of THRIVE in esophagology.
UNASSIGNED: We conducted a retrospective review of adult patients undergoing esophageal procedures under general anesthesia who were oxygenated using THRIVE at two academic institutions. Demographic, clinical, and anesthesiologic data were collected and analyzed.
UNASSIGNED: 14 cases performed from March 2021 to March 2022 met inclusion criteria. 13/14 (92.9%) of patients were able to maintain oxygenation throughout the entirety of their procedure. The mean apneic time was 17.9 minutes with a maximum of 32 minutes. One patient required \"rescue\" intubation due to failure to maintain oxygenation. Excluding the sole THRIVE failure, the median SpO2 at the conclusion of surgery was 99% (range 94-100%). A linear regression model yielded an increase in EtCO2 of 0.95 mmHg/min or 0.127 kPa/min. SpO2 was negatively associated with both tobacco pack-year smoking history (R2 = 0.343, P = .014) and BMI (R2 = 0.238, P = .038).
UNASSIGNED: THRIVE is a feasible, safe, and efficacious means of apneic oxygenation for patients undergoing esophageal endoscopic surgery under general anesthesia with neuromuscular paralysis, which may be particularly beneficial in patients with airway stenosis, as post-intubation changes can have severe clinical implications for this patient population. Obese patients and tobacco smokers may be at increased risk of oxygen desaturation when using THRIVE.
UNASSIGNED: We conducted a retrospective review of adult patients undergoing esophageal procedures under general anesthesia who were oxygenated using THRIVE at two academic institutions. Demographic, clinical, and anesthesiologic data were collected and analyzed.
UNASSIGNED: 14 cases performed from March 2021 to March 2022 met inclusion criteria. 13/14 (92.9%) of patients were able to maintain oxygenation throughout the entirety of their procedure. The mean apneic time was 17.9 minutes with a maximum of 32 minutes. One patient required \"rescue\" intubation due to failure to maintain oxygenation. Excluding the sole THRIVE failure, the median SpO2 at the conclusion of surgery was 99% (range 94-100%). A linear regression model yielded an increase in EtCO2 of 0.95 mmHg/min or 0.127 kPa/min. SpO2 was negatively associated with both tobacco pack-year smoking history (R2 = 0.343, P = .014) and BMI (R2 = 0.238, P = .038).
UNASSIGNED: THRIVE is a feasible, safe, and efficacious means of apneic oxygenation for patients undergoing esophageal endoscopic surgery under general anesthesia with neuromuscular paralysis, which may be particularly beneficial in patients with airway stenosis, as post-intubation changes can have severe clinical implications for this patient population. Obese patients and tobacco smokers may be at increased risk of oxygen desaturation when using THRIVE.
摘要：
■经鼻加湿快速吹气换气（THRIVE）描述了使用加湿高流量鼻插管氧气的呼吸暂停氧合。尽管它被描述为内窥镜喉气管手术中唯一的氧合模式，在神经肌肉麻痹的全身麻醉下的内镜食管手术中的使用以前没有被描述过。这项研究的目的是评估THRIVE在食道学中的安全性和有效性。
我们在两个学术机构对在全身麻醉下接受食道手术并使用THRIVE充氧的成年患者进行了回顾性研究。人口统计,临床,收集和分析麻醉数据。
■从2021年3月至2022年3月进行的14例病例符合纳入标准。13/14（92.9％）的患者能够在整个过程中保持氧合。平均呼吸暂停时间为17.9分钟，最长为32分钟。一名患者因无法维持氧合而需要“抢救”插管。排除唯一的THRIVE故障，手术结束时的SpO2中位数为99%(94-100%).线性回归模型产生了0.95mmHg/min或0.127kPa/min的EtCO2增加。SpO2与烟草包装年吸烟史（R2=0.343，P=0.014）和BMI（R2=0.238，P=0.038）呈负相关。
■成功是可行的，安全,全麻食管内镜手术伴神经肌肉麻痹患者的呼吸暂停氧合的有效方法，这对气道狭窄患者可能特别有益，因为插管后的变化可能对该患者人群产生严重的临床意义。肥胖患者和吸烟者使用THRIVE时，氧饱和度降低的风险可能会增加。
我们在两个学术机构对在全身麻醉下接受食道手术并使用THRIVE充氧的成年患者进行了回顾性研究。人口统计,临床,收集和分析麻醉数据。
■从2021年3月至2022年3月进行的14例病例符合纳入标准。13/14（92.9％）的患者能够在整个过程中保持氧合。平均呼吸暂停时间为17.9分钟，最长为32分钟。一名患者因无法维持氧合而需要“抢救”插管。排除唯一的THRIVE故障，手术结束时的SpO2中位数为99%(94-100%).线性回归模型产生了0.95mmHg/min或0.127kPa/min的EtCO2增加。SpO2与烟草包装年吸烟史（R2=0.343，P=0.014）和BMI（R2=0.238，P=0.038）呈负相关。
■成功是可行的，安全,全麻食管内镜手术伴神经肌肉麻痹患者的呼吸暂停氧合的有效方法，这对气道狭窄患者可能特别有益，因为插管后的变化可能对该患者人群产生严重的临床意义。肥胖患者和吸烟者使用THRIVE时，氧饱和度降低的风险可能会增加。
