Rigal Tiffany, Baudouin Robin, Circiu Marta, Couineau Florent, Lechien Jérôme, Crevier-Buchman Lise, Le Guen Morgan, Hans Stéphane
Department of Otolaryngology-Head and Neck Surgery Foch Hospital Suresnes France.
School of Medicine, UFR Simone Veil Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University) Montigny-le-Bretonneux France.
OTO Open. 2024 Jun 11;8(2):e125. doi: 10.1002/oto2.125. eCollection 2024 Apr-Jun.
Since 2015, Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) has been used in general anesthesia for preoxygenation or difficult exposure airway management. Its use offers new opportunities in laryngology. THRIVE increases apnea time and frees the access to the upper airway. However, its use may be less stable than orotracheal intubation. The main objective of this work was to evaluate the feasibility of laryngeal microsurgery under THRIVE including using Laser.
Retrospective.
A total of N = 99 patients with laryngeal microsurgery (with or without CO laser) under THRIVE were included successively from January 1, 2020 to January 30, 2022.
Medical history, comorbidities, clinical and surgical data were extracted and analyzed. Two groups were constituted regarding the "success" (use of THRIVE along all the procedure) or the "failure" (need for an endotracheal tube) of the use of THRIVE during the procedure.
A failure occurred in N = 15/99 patients (15.2%) mainly due to refractory hypoxia. The odd ratios (OR) for THRIVE failure were: OR = 6.6 [2.9-35] for overweight (BMI >25 kg/m); OR = 3.8 [1.7-18.7] for ASA score >2; OR = 4.7 [2.3-24.7] for the use of CO laser. Elderly patients and patients with pulmonary pathology were not statistically at greater risk of THRIVE failure. No adverse event was described.
This work confirms the feasibility of laryngeal microsurgery under THRIVE, including with CO laser. Overweight, ASA >2 and lower fraction of inspired oxygen during CO laser use increased the risk for orotracheal intubation.
自2015年以来，经鼻湿化快速吹气通气交换（THRIVE）已用于全身麻醉中的预给氧或困难气道暴露管理。其应用为喉科学带来了新机遇。THRIVE可延长呼吸暂停时间并使上气道的操作更便捷。然而，其应用可能不如气管插管稳定。本研究的主要目的是评估在THRIVE支持下进行包括使用激光在内的喉显微手术的可行性。
回顾性研究。
2020年1月1日至2022年1月30日期间，相继纳入了总共N = 99例在THRIVE支持下进行喉显微手术（使用或不使用CO激光）的患者。
提取并分析病史、合并症、临床和手术数据。根据手术过程中THRIVE的“成功”（整个手术过程均使用THRIVE）或“失败”（需要气管插管）情况分为两组。
N = 15/99例患者（15.2%）出现失败，主要原因是难治性缺氧。THRIVE失败的比值比（OR）为：超重（BMI>25 kg/m²）时OR = 6.6 [2.9 - 35]；美国麻醉医师协会（ASA）评分>2时OR = 3.8 [1.7 - 18.7]；使用CO激光时OR = 4.7 [2.3 - 24.7]。老年患者和肺部疾病患者在统计学上并非THRIVE失败的高风险人群。未描述有不良事件发生。
本研究证实了在THRIVE支持下进行喉显微手术的可行性，包括使用CO激光。超重、ASA>2以及在使用CO激光时较低的吸入氧分数增加了气管插管的风险。
