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Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) and its Utility in Otolaryngology, Head and Neck Surgery: A Literature Review

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Abstract

High-flow nasal oxygen (HFNO) therapy is extensively used in critical care units for spontaneously breathing patients. Trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) is a method of apnoeic oxygenation with continuous nasal delivery of warmed, humidified oxygen at high-flow rates up to 70L/min. THRIVE extends the apnoeic window before desaturation occurs so that tubeless anaesthesia is possible. The advent of THRIVE has had a monumental impact on anaesthetic practice, with a diverse range of clinical applications and it has been incorporated into difficult airway guidelines. THRIVE has many applications in otolaryngology and head and neck surgery. It is used as a pre-oxygenation tool during induction in both anticipated and unanticipated difficult airway scenarios and as a method of oxygenation for tubeless anaesthesia in elective laryngotracheal and hypopharyngeal surgeries and during emergence from anaesthesia. In this scoping review of the literature, we aim to provide an overview on the utility of THRIVE in otolaryngology, including the underlying physiologic principles, current indications and limitations, and its feasibility and safety in different surgical contexts and specific population groups.

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Abbreviations

CO2 :

Carbon dioxide

FiO2 :

Fraction of inspired oxygen

FRC:

Functional residual capacity

HFNO:

High-flow nasal oxygen

PEEP:

Positive end-expiratory pressure

KTP:

Potassium titanyl phosphate

RCTs:

Randomised controlled trials

THRIVE:

Trans-nasal humidified rapid insufflation ventilatory exchange

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Authors and Affiliations

  1. Department of Otolaryngology, Westmead Hospital, Westmead, NSW, 2145, Australia

    Saikrishna Ananthapadmanabhan, Mark Smith & Faruque Riffat

  2. Department of Head and Neck Surgical Oncology, Cytecare Cancer Hospital, Bangalore, Karnataka, India

    Akshay Kudpaje

  3. Department of Anaesthesia, Critical Care, and Pain, Cytecare Cancer Hospital, Bangalore, Karnataka, India

    Dinesh Raju

  4. Chris O’Brien Lifehouse, Camperdown, NSW, Australia

    Mark Smith, Faruque Riffat, Daniel Novakovic, Murray Stokan & Carsten E. Palme

  5. The Canterbury Hospital, Campsie, NSW, Australia

    Daniel Novakovic

  6. Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia

    Daniel Novakovic

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  1. Saikrishna Ananthapadmanabhan
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  2. Akshay Kudpaje
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  3. Dinesh Raju
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  4. Mark Smith
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  5. Faruque Riffat
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  6. Daniel Novakovic
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  7. Murray Stokan
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  8. Carsten E. Palme
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Correspondence to Saikrishna Ananthapadmanabhan.

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Ethical approval was not required for this project – it is a literature review and does not include any patient data. This project complies with the ethical standards of the institution’s research ethics committee.

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Ananthapadmanabhan, S., Kudpaje, A., Raju, D. et al. Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) and its Utility in Otolaryngology, Head and Neck Surgery: A Literature Review. Indian J Otolaryngol Head Neck Surg 76, 1921–1930 (2024). https://doi.org/10.1007/s12070-023-04445-2

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