Ferraro Ellen L, Zura Nicholas, Abdelmalak Basem B, Galway Ursula, Benninger Michael S, Bryson Paul C
Department of Otolaryngology, Division of Laryngology, University of Rochester Medical Center, Rochester, New York, U.S.A.
Department of Otolaryngology, Division of Laryngology, Wayne State School of Medicine, Detroit, Michigan, U.S.A.
Laryngoscope. 2025 Jan;135(1):223-226. doi: 10.1002/lary.31733. Epub 2024 Sep 7.
High-flow nasal oxygen (HFNO), or transnasal humidified rapid-insufflation ventilatory exchange (THRIVE), is a technique providing apneic oxygenation and a degree of ventilation during microlaryngeal surgery. Its use with laser has been questioned due to concern for airway fire. For fire to occur, a triad of ignition source, oxidizer, and fuel source must be present. By using HFNO and eliminating an endotracheal tube (fuel source), it is hypothesized that airway fire risk is minimal. We tested this theory with human cadavers using HFNO with increasing levels of FiO while performing microlaryngeal laser surgery.
HFNO was placed on two cadavers, and oxygen was administered at incrementally increasing fraction of inspired oxygen (FiO) concentrations (30%-100%). Laryngeal microsurgery was conducted with CO and KTP lasers applied for 30 s. Oxygen readings were taken at several anatomic locations along the body assessing oxygen concentrations in correlation with increasing FiO administration.
The use of CO and KTP laser on cadaveric vocal folds produced char but no spark or airway fire at any of the tested oxygen concentrations. Apart from the mouth, there was minimal increase in oxygen levels at the surrounding anatomic sites despite elevating FiO levels.
HFNO may be safe to use during microlaryngeal laser surgery. By eliminating the endotracheal tube as a fuel source, risk of airway fire may be negligible. Our study safely applied CO and KTP lasers for an uninterrupted 30 s with HFNO at 70 L/min and 100% FiO producing no spark or fire.
NA Laryngoscope, 135:223-226, 2025.
高流量鼻导管给氧（HFNO），即经鼻湿化快速充气通气交换（THRIVE），是一种在显微喉镜手术期间提供无呼吸氧合及一定程度通气的技术。由于担心气道起火，其与激光联合使用一直受到质疑。要发生火灾，必须同时存在火源、氧化剂和燃料源这三个要素。通过使用HFNO并去除气管内导管（燃料源），推测气道起火风险极小。我们在人体尸体上进行显微喉镜激光手术时，使用HFNO并逐渐增加吸入氧分数（FiO₂）水平来验证这一理论。
将HFNO置于两具尸体上，并以递增的吸入氧分数（FiO₂）浓度（30% - 100%）给予氧气。使用CO₂和KTP激光进行30秒的喉显微手术。在身体的几个解剖位置进行氧读数，评估与递增FiO₂给药相关的氧浓度。
在尸体声带使用CO₂和KTP激光，在任何测试的氧浓度下均产生碳化但无火花或气道起火。除口腔外，尽管FiO₂水平升高，但周围解剖部位的氧水平仅有极小增加。
HFNO在显微喉镜激光手术期间使用可能是安全的。通过去除气管内导管作为燃料源，气道起火风险可能可忽略不计。我们的研究在70L/min流量和100%FiO₂的HFNO条件下，安全地连续30秒应用CO₂和KTP激光，未产生火花或火灾。
NA 喉镜，135:223 - 226，2025年。
