| Abstract | Maintaining ventilation is vital for patients under general anesthesia. However, establishing a patent airway can prove problematic: repeated attempts to intubate can lead to airway trauma that makes subsequent attempts far more difficult. Anesthesia-care providers (ACPs) must prevent hypoxic injury and establish an airway during the "apneic window", which stretches from the administration of a neuromuscular blocking agent to the establishment of a definitive airway and effective ventilation. Should intubation prove impossible, ACPs find themselves in the dangerous "can't intubate, can't ventilate" scenario (Patel et al., 2015). Various methods of prolonging the tolerance of the apneic window have focused on the period of time prior to intubation. Some patients are at increased risk of aspirating stomach contents into their lungs during intubation, and this expedited version of induction and intubation is known as rapid sequence induction (RSI). Since this procedure does not include administering positive pressure breaths to verify their airway patency prior to the administration of muscular blocking agents, there is a heightened concern regarding the ability to secure an airway- thus prolonging the apneic window- for these patients. Within the last ten years, a new method of prolonging the apneic window, Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE), has shown promising results related to maintaining oxygen saturation and preventing excess accumulation of CO2 during RSI (Doyle et al., 2016; Gustafsson et al., 2017). The THRIVE technique involves the administration of 40-70 liters per minute of warmed, humidified 100% oxygen via a nasal cannula. The high flow rate helps entrain and expel CO2 from the lungs and fosters apneic oxygenation with the 100% oxygen contained in the pharynx (Gustafsson et al., 2017). Because it is still considered a novel technique, it has not yet been widely adopted in the United States, despite its promising results in studies thus far. This review includes: 1) the physiological basis for the mechanism of THRIVE, 2) the length of the apneic window in comparison with traditional methods of preoxygenation, and 3) the incidence of significant desaturation and hypoxemia in patients utilizing THRIVE vs. other traditional methods of preoxygenation. Databases searched included Pubmed, Embase, CINAHL. The terms included transnasal humidified rapid insufflation ventilatory exchange, rapid sequence induction, apneic window, hypoxemia, and pre-oxygenation. 12 articles were identified and reviewed. According to the results of the 12 articles and studies, THRIVE is capable of lengthening the mean apneic time in many patients and reducing the incidence of significant desaturation and hypoxemia. Keywords: transnasal humidified rapid insufflation ventilatory exchange, rapid sequence induction, apnea, desaturation |
