AUTHOR=Lin Chunmei , Wang Dandan , Yan Yulu , Zhong Ruihan , Li Chaoyang , Zhang Jie 

TITLE=Transnasal humidified rapid-insufflation ventilator exchange compared with laryngeal mask airway for endoscopic thoracic sympathectomy: a randomized controlled trial

JOURNAL=Frontiers in Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1252586

DOI=10.3389/fmed.2023.1252586

ISSN=2296-858X

ABSTRACT=<sec id="sec1"><title>Background</title><p>Transnasal humidified rapid-insufflation ventilator exchange (THRIVE) has the characteristics of operating easily and maintaining oxygenation and eliminating CO<sub>2</sub>, which makes it possible to be used in endoscopic thoracic sympathectomy (ETS). The application of THRIVE in ETS remains undefined. The purpose of this randomized controlled study is to assess the efficacy between THRIVE and laryngeal mask airway (LMA) for ETS.</p></sec><sec id="sec2"><title>Methods</title><p>In total, 34 patients from May 2022 to May 2023 in Huazhong University of Science and Technology Union Shenzhen Hospital undergoing ETS were randomly divided into a THRIVE group (<italic>n</italic> = 17) and an LMA group (<italic>n</italic> = 17). A serial arterial blood gas analysis was conducted during the perioperative period. The primary outcome was the arterial partial pressure of carbon dioxide (PaCO<sub>2</sub>) during the perioperative period. The secondary outcome was arterial partial pressure of oxygen (PaO<sub>2</sub>) during the perioperative period.</p></sec><sec id="sec3"><title>Results</title><p>The mean (SD) highest PaCO<sub>2</sub> in the THRIVE group and LMA group were 99.0 (9.0) mmHg and 51.7 (5.2) mmHg, respectively (<italic>p</italic> &lt; 0.001). The median (inter-quartile range) time to PaCO<sub>2</sub> ≥ 60 mmHg in the THRIVE group was 26.0 min (23.2–28.8). The mean (SD) PaO<sub>2</sub> was 268.8 (89.0) mmHg in the THRIVE group and 209.8 (55.8) mmHg in the LMA group during surgery (<italic>p</italic> = 0.027).</p></sec><sec id="sec4"><title>Conclusion</title><p>CO<sub>2</sub> accumulation in the THRIVE group was higher than that of the LMA group during ETS, but THRIVE exhibited greater oxygenation capability compared to LMA. We preliminarily testified that THRIVE would be a feasible non-intubated ventilation technique during ETS under monitoring PaCO<sub>2.</sub></p></sec>