Lung volume changes in Apnoeic Oxygenation using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) compared to mechanical ventilation in adults undergoing laryngeal surgery.
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
06
02
2020
revised:
22
06
2020
accepted:
04
08
2020
pubmed:
15
8
2020
medline:
16
10
2021
entrez:
15
8
2020
Statut:
ppublish
Résumé
Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) using high-flow 100% oxygen during apnoea has gained increased use during difficult airway management and laryngeal surgery due to a slower carbon dioxide rise compared to traditional apnoeic oxygenation. We have previously demonstrated high arterial oxygen partial pressures and an increasing arterial-alveolar carbon dioxide difference during THRIVE. Primary aim of this study was to characterise lung volume changes measured with electrical impedance tomography during THRIVE compared to mechanical ventilation. Thirty adult patients undergoing laryngeal surgery under general anaesthesia were randomised to THRIVE or mechanical ventilation. Subjects were monitored with electrical impedance tomography and repeated blood gas measurement perioperatively. The THRIVE group received 100% oxygen at 70 l min Mean age were 48.2 (19.9) and 51.3 (12.3) years, and BMI 26.0 (4.5) and 26.0 (3.9) in the THRIVE and mechanical ventilation group respectively. Mean apnoea time in the THRIVE group was 17.9 (4.8) min. Mean apnoea to end-of-surgery time was 28.1 (12.8) min in the mechanical ventilation group. No difference in delta End Expiratory Lung Impedance was seen between groups over time. In the THRIVE group all but three subjects were well oxygenated during apnoea. THRIVE was discontinued for the three patients who desaturated. No difference in lung volume change over time, measured by electrical impedance tomography, was detected when using THRIVE compared to mechanical ventilation during laryngeal surgery.
Sections du résumé
BACKGROUND
Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) using high-flow 100% oxygen during apnoea has gained increased use during difficult airway management and laryngeal surgery due to a slower carbon dioxide rise compared to traditional apnoeic oxygenation. We have previously demonstrated high arterial oxygen partial pressures and an increasing arterial-alveolar carbon dioxide difference during THRIVE. Primary aim of this study was to characterise lung volume changes measured with electrical impedance tomography during THRIVE compared to mechanical ventilation.
METHODS
Thirty adult patients undergoing laryngeal surgery under general anaesthesia were randomised to THRIVE or mechanical ventilation. Subjects were monitored with electrical impedance tomography and repeated blood gas measurement perioperatively. The THRIVE group received 100% oxygen at 70 l min
RESULTS
Mean age were 48.2 (19.9) and 51.3 (12.3) years, and BMI 26.0 (4.5) and 26.0 (3.9) in the THRIVE and mechanical ventilation group respectively. Mean apnoea time in the THRIVE group was 17.9 (4.8) min. Mean apnoea to end-of-surgery time was 28.1 (12.8) min in the mechanical ventilation group. No difference in delta End Expiratory Lung Impedance was seen between groups over time. In the THRIVE group all but three subjects were well oxygenated during apnoea. THRIVE was discontinued for the three patients who desaturated.
CONCLUSIONS
No difference in lung volume change over time, measured by electrical impedance tomography, was detected when using THRIVE compared to mechanical ventilation during laryngeal surgery.
Identifiants
pubmed: 32794176
doi: 10.1111/aas.13686
pmc: PMC7589281
doi:
Substances chimiques
Carbon Dioxide
142M471B3J
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1491-1498Informations de copyright
© 2020 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
Références
Br J Anaesth. 2017 Apr 1;118(4):610-617
pubmed: 28403407
J Appl Physiol Respir Environ Exerc Physiol. 1981 Nov;51(5):1287-93
pubmed: 7298465
Br J Anaesth. 2015 Oct;115(4):629-32
pubmed: 26253608
Intensive Care Med. 2003 Jan;29(1):37-43
pubmed: 12528020
Respir Care. 2011 Aug;56(8):1151-5
pubmed: 21496369
Med Hypotheses. 1982 Apr;8(4):393-400
pubmed: 6808323
Sci Rep. 2019 Jul 5;9(1):9796
pubmed: 31278297
Acta Anaesthesiol Scand. 2020 Nov;64(10):1491-1498
pubmed: 32794176
Br J Anaesth. 2017 Feb;118(2):232-238
pubmed: 28100527
Crit Care Med. 2008 Apr;36(4):1230-8
pubmed: 18379250
Anaesthesia. 2015 Mar;70(3):323-9
pubmed: 25388828
Acta Anaesthesiol Scand. 1987 Jan;31(1):21-4
pubmed: 3825472
Acta Anaesthesiol Scand. 2011 Jan;55(1):75-81
pubmed: 21039356
Am J Physiol. 1964 Jul;207:235-8
pubmed: 14193596
Anaesth Intensive Care. 2018 Jul;46(4):360-367
pubmed: 29966108
Aust Crit Care. 2007 Nov;20(4):126-31
pubmed: 17931878
Anaesthesia. 2018 May;73(5):564-571
pubmed: 29330853
Anaesthesia. 2019 Apr;74(4):441-449
pubmed: 30767199
Acta Anaesthesiol Scand. 1986 Feb;30(2):154-8
pubmed: 3705902
J Clin Monit Comput. 2000;16(5-6):329-35
pubmed: 12580216
Anesthesiology. 1961 May-Jun;22:419-25
pubmed: 13725901
Acta Anaesthesiol Scand. 1996 May;40(5):524-9
pubmed: 8792880
Acta Anaesthesiol Scand. 2011 Oct;55(9):1068-77
pubmed: 22092203
Anesthesiology. 1973 Dec;39(6):588-96
pubmed: 4761019
Anaesthesia. 2017 Nov;72(11):1379-1387
pubmed: 29047136
Intensive Care Med. 2009 Jun;35(6):1132-7
pubmed: 19255741
Anaesthesia. 2017 Apr;72(4):439-443
pubmed: 28035669
Br J Anaesth. 2011 Dec;107(6):998-1004
pubmed: 21908497
Curr Opin Crit Care. 2012 Feb;18(1):35-41
pubmed: 22201705
Anesthesiology. 1997 Oct;87(4):979-82
pubmed: 9357902