Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, CA, USA.
Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA.
Laryngoscope. 2020 Dec;130(12):E874-E881. doi: 10.1002/lary.28562. Epub 2020 Feb 20.
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is an intraoperative ventilatory technique that allows avoidance of tracheal intubation (TI) or jet ventilation (JV) in selected laryngologic surgical cases. Unimpeded access to all parts of the glottis may improve surgical precision, decrease operative time, and potentially improve patient outcomes. The objective of this prospective, randomized, patient-blinded, 2-arm parallel pilot trial was to investigate the safety and efficacy of THRIVE use for adult patients undergoing nonlaser laryngologic surgery of short-to-intermediate duration.
Twenty adult, American society of anesthesiology class 1-3 patients with body mass index (BMI) < 35 kg/m were randomly assigned to either an experimental THRIVE group or active comparator conventional ventilation group (TI or supraglottic high-frequency JV [SHFJV]). Primary outcomes included intraoperative oxygenation, anesthesia awakening/extubation time, time to laryngoscopic suspension, number of intraoperative suspension adjustments, and operative time. Secondary patient outcomes including postanesthesia and functional patient recovery were investigated.
Compared to TI/SHFJV, THRIVE use was associated with significantly lower intraoperative oxygenation (SpO 93.0 ± 5.6% vs. 98.7 ± 1.6%), shorter time to suspension (1.8 ± 1.1 minutes vs. 4.3 ± 2.1 minutes), fewer suspension adjustments (0.4 ± 0.5 vs. 1.7 ± 0.9), and lower postoperative pain scores on recovery room admission (1.3 ± 1.9 vs. 3.7 ± 2.9) and discharge (0.9 ± 1.3 vs. 2.7 ± 1.8). The study was underpowered to detect other possible outcome differences.
We confirm the safe intraoperative oxygenation profile of THRIVE for selected patients undergoing nonlaser laryngologic surgery of short-to-intermediate duration. THRIVE facilitated surgical exposure and improved early patient recovery, suggesting a potential economic benefit for outpatient laryngologic procedures. The results of this exploratory study provide a framework for designing future adequately powered THRIVE trials.
ClinicalTrials.gov (NCT03091179).
II Laryngoscope, 2020.
经鼻湿化快速充气交换通气（THRIVE）是一种术中通气技术，可在选择的喉科手术病例中避免气管插管（TI）或射流通气（JV）。无障碍地进入声门的所有部位可能会提高手术精度，缩短手术时间，并可能改善患者的预后。本前瞻性、随机、患者盲法、双臂平行试验的目的是研究 THRIVE 在接受非激光喉科手术的短至中程成人患者中的安全性和有效性。
20 名美国麻醉医师协会（ASA）分级 1-3 级、体重指数（BMI）<35kg/m 的成年患者被随机分配到实验组 THRIVE 组或主动对照常规通气组（TI 或声门上高频 JV [SHFJV]）。主要结局包括术中氧合、麻醉苏醒/拔管时间、喉镜悬吊时间、术中悬吊调整次数和手术时间。还调查了次要的患者结局，包括麻醉后和功能恢复。
与 TI/SHFJV 相比，THRIVE 组术中氧合明显降低（SpO2 93.0±5.6% vs. 98.7±1.6%），悬吊时间更短（1.8±1.1 分钟 vs. 4.3±2.1 分钟），悬吊调整次数更少（0.4±0.5 次 vs. 1.7±0.9 次），术后入恢复室时疼痛评分较低（1.3±1.9 分 vs. 3.7±2.9 分）和出院时（0.9±1.3 分 vs. 2.7±1.8 分）。本研究的功率不足，无法检测到其他可能的结果差异。
我们证实了 THRIVE 用于选择的短至中程非激光喉科手术患者的术中安全氧合谱。THRIVE 促进了手术暴露，并改善了患者的早期恢复，这表明门诊喉科手术可能具有经济效益。这项探索性研究的结果为设计未来的 THRIVE 试验提供了框架。
ClinicalTrials.gov（NCT03091179）。
II 级。喉镜，2020 年。
