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. 2021 Jan;135(1):86-87.
doi: 10.1017/S0022215120002753. Epub 2021 Jan 7.

Transnasal humidified rapid-insufflation ventilatory exchange ('THRIVE') in the coronavirus disease 2019 pandemic

S Y Hey  1 , P Milligan  2 , R M Adamson  1 , I J Nixon  1 , A F McNarry  2
Affiliations

Transnasal humidified rapid-insufflation ventilatory exchange ('THRIVE') in the coronavirus disease 2019 pandemic

S Y Hey et al. J Laryngol Otol. 2021 Jan.

Abstract

Background: Since the start of the coronavirus disease 2019 pandemic, transnasal humidified rapid-insufflation ventilatory exchange ('THRIVE') has been classified as a high-risk aerosol-generating procedure and is strongly discouraged, despite a lack of conclusive evidence on its safety.

Methods: This study aimed to investigate the safety of transnasal humidified rapid-insufflation ventilatory exchange usage and its impact on staff members. A prospective study was conducted on all transnasal humidified rapid-insufflation ventilatory exchange cases performed in our unit between March and July 2020.

Results: During the study period, 18 patients with a variety of airway pathologies were successfully managed with transnasal humidified rapid-insufflation ventilatory exchange. For each case, 7-10 staff members were present. Appropriate personal protective equipment protocols were strictly implemented and adhered to. None of the staff involved reported symptoms or tested positive for coronavirus disease 2019, up to at least a month following their exposure to transnasal humidified rapid-insufflation ventilatory exchange.

Conclusion: With strictly correct personal protective equipment use, transnasal humidified rapid-insufflation ventilatory exchange can be safely employed for carefully selected patients in the current pandemic, without jeopardising the health and safety of the ENT and anaesthetic workforce.

Keywords: Airway Management; Anesthesia; COVID-19; Continuous Positive Airway Pressure; Insufflation; Intubation; Larynx; Oxygen; Trachea.

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Conflict of interest statement

None declared

Figures

Fig. 1.
Fig. 1.
Total daily new cases of coronavirus disease 2019 (Covid-19) in NHS Lothian and dates (red-dotted) on which transnasal humidified rapid-insufflation ventilatory exchange (‘THRIVE’) was performed in our unit. (Data courtesy of John Frace, University of Highlands and Islands, Scotland.)
See this image and copyright information in PMC

References

    1. ENT UK guidelines for changes in ENT during COVID-19 pandemic. In: https://www.entuk.org/ent-uk-guidelines-changes-ent-during-covid-19-pand... [28 August 2020]
    1. Healy DW, Cloyd BH, Brenner MJ, Kupfer RA, Anam KS, Schechtman SA. The COVID-19 pandemic: implications for the head and neck anesthesiologist. Journal of Head & Neck Anesthesia 2020;4:e26
    1. Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: guidelines from the Difficult Airway Society, the Association of Anaesthetists, the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020;75:785–99 - PMC - PubMed
    1. COVID-19. In: https://www.entuk.org/covid-19 [28 August 2020]
    1. Balakrishnan K, Schechtman S, Hogikyan ND, Teoh AYB, McGrath B, Brenner MJ. COVID-19 pandemic: what every otolaryngologist–head and neck surgeon needs to know for safe airway management. Otolaryngol Head Neck Surg 2020;162:804–8 - PubMed