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SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management of the obstructed airway: an observational study.
Br J Anaesth. 2017 Mar 01; 118(3):444-451.BJ

Abstract

Background

High-flow nasal oxygen (HFNO) has been shown to benefit oxygenation, ventilation and upper airway patency in a range of clinical scenarios, however its use in spontaneously breathing patients during general anaesthesia has not been described. Spontaneous respiration using i.v. anaesthesia is the primary technique used at our institution for tubeless airway surgery. We hypothesized that the addition of HFNO would increase our margin of safety, particularly during management of an obstructed airway.

Methods

A retrospective observational study was conducted using a SponTaneous Respiration using IntraVEnous anaesthesia and High-flow nasal oxygen (STRIVE Hi) technique to manage 30 adult patients undergoing elective laryngotracheal surgery.

Results

Twenty-six patients (87%) presented with significant airway and/or respiratory compromise (16 were stridulous, 10 were dyspnoeic). No episodes of apnoea or complete airway obstruction occurred during the induction of anaesthesia using STRIVE Hi. The median [IQR (range)] lowest oxygen saturation during the induction period was 100 [99–100 (97–100)] %. The median [IQR (range)] overall duration of spontaneous ventilation was 44 [40–49.5 (18–100)] min. The median [IQR (range)] end-tidal carbon dioxide (ETCO2) level at the end of the spontaneous ventilation period was 6.8 [6.4–7.1 (4.8–8.9)] kPa. The mean rate of increase in ETCO2 was 0.03 kPa min−1.

Conclusions

STRIVE Hi succeeded in preserving adequate oxygen saturation, end-tidal carbon dioxide and airway patency. We suggest that the upper and lower airway benefits attributed to HFNO, are ideally suited to a spontaneous respiration induction, increasing its margin of safety. STRIVE Hi is a modern alternative to the traditional inhalation induction.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28203745

Citation

Booth, A W G., et al. "SponTaneous Respiration Using IntraVEnous Anaesthesia and Hi-flow Nasal Oxygen (STRIVE Hi) Maintains Oxygenation and Airway Patency During Management of the Obstructed Airway: an Observational Study." British Journal of Anaesthesia, vol. 118, no. 3, 2017, pp. 444-451.
Booth AWG, Vidhani K, Lee PK, et al. SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management of the obstructed airway: an observational study. Br J Anaesth. 2017;118(3):444-451.
Booth, A. W. G., Vidhani, K., Lee, P. K., & Thomsett, C. M. (2017). SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management of the obstructed airway: an observational study. British Journal of Anaesthesia, 118(3), 444-451. https://doi.org/10.1093/bja/aew468
Booth AWG, et al. SponTaneous Respiration Using IntraVEnous Anaesthesia and Hi-flow Nasal Oxygen (STRIVE Hi) Maintains Oxygenation and Airway Patency During Management of the Obstructed Airway: an Observational Study. Br J Anaesth. 2017 Mar 1;118(3):444-451. PubMed PMID: 28203745.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management of the obstructed airway: an observational study. AU - Booth,A W G, AU - Vidhani,K, AU - Lee,P K, AU - Thomsett,C-M, PY - 2016/12/20/accepted PY - 2017/2/17/entrez PY - 2017/2/17/pubmed PY - 2018/12/12/medline SP - 444 EP - 451 JF - British journal of anaesthesia JO - Br J Anaesth VL - 118 IS - 3 N2 - Background: High-flow nasal oxygen (HFNO) has been shown to benefit oxygenation, ventilation and upper airway patency in a range of clinical scenarios, however its use in spontaneously breathing patients during general anaesthesia has not been described. Spontaneous respiration using i.v. anaesthesia is the primary technique used at our institution for tubeless airway surgery. We hypothesized that the addition of HFNO would increase our margin of safety, particularly during management of an obstructed airway. Methods: A retrospective observational study was conducted using a SponTaneous Respiration using IntraVEnous anaesthesia and High-flow nasal oxygen (STRIVE Hi) technique to manage 30 adult patients undergoing elective laryngotracheal surgery. Results: Twenty-six patients (87%) presented with significant airway and/or respiratory compromise (16 were stridulous, 10 were dyspnoeic). No episodes of apnoea or complete airway obstruction occurred during the induction of anaesthesia using STRIVE Hi. The median [IQR (range)] lowest oxygen saturation during the induction period was 100 [99–100 (97–100)] %. The median [IQR (range)] overall duration of spontaneous ventilation was 44 [40–49.5 (18–100)] min. The median [IQR (range)] end-tidal carbon dioxide (ETCO2) level at the end of the spontaneous ventilation period was 6.8 [6.4–7.1 (4.8–8.9)] kPa. The mean rate of increase in ETCO2 was 0.03 kPa min−1. Conclusions: STRIVE Hi succeeded in preserving adequate oxygen saturation, end-tidal carbon dioxide and airway patency. We suggest that the upper and lower airway benefits attributed to HFNO, are ideally suited to a spontaneous respiration induction, increasing its margin of safety. STRIVE Hi is a modern alternative to the traditional inhalation induction. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/28203745/SponTaneous_Respiration_using_IntraVEnous_anaesthesia_and_Hi_flow_nasal_oxygen__STRIVE_Hi__maintains_oxygenation_and_airway_patency_during_management_of_the_obstructed_airway:_an_observational_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)30215-5 DB - PRIME DP - Unbound Medicine ER -