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2015•Critical CareOpen access

Transnasal humidified rapid insufflation ventilatory exchange for pre-oxygenation and apnoeic oxygenation during rapid sequence induction

Maryanne Mariyaselvam, Daniel Stolady, Gayathri Wijewardena, M Blunt, Peter Young

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Abstract

Rapid sequence induction (RSI) in the ICU, emergency department (ED) and operating room (OR) carries the risk of hypoxemia if laryngoscopy is prolonged especially in high-risk patients. Bag and mask pre-oxygenation is normally used to extend the apnoea time; however, arterial desaturation may still rapidly occur. Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a new technique that provides modest CPAP during pre-oxygenation and crucially also continuous oxygenation of the pharyngeal space throughout the apnoeic period. In elective surgery, THRIVE provides apnoea times as long as 60 minutes due to apnoeic oxygenation [ 1 ]. We report the first implementation of THRIVE with emergency patients into the ICU, ED and OR.

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Rapid sequence induction (RSI) in the ICU, emergency department (ED) and operating room (OR) carries the risk of hypoxemia if laryngoscopy is prolonged especially in high-risk patients. Bag and mask pre-oxygenation is normally used to extend the apnoea time; however, arterial desaturation may still rapidly occur. Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a new technique that provides modest CPAP during pre-oxygenation and crucially also continuous oxygenation of the pharyngeal space throughout the apnoeic period. In elective surgery, THRIVE provides apnoea times as long as 60 minutes due to apnoeic oxygenation [ 1 ]. We report the first implementation of THRIVE with emergency patients into the ICU, ED and OR.

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Available abstract

Rapid sequence induction (RSI) in the ICU, emergency department (ED) and operating room (OR) carries the risk of hypoxemia if laryngoscopy is prolonged especially in high-risk patients. Bag and mask pre-oxygenation is normally used to extend the apnoea time; however, arterial desaturation may still rapidly occur. Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) is a new technique that provides modest CPAP during pre-oxygenation and crucially also continuous oxygenation of the pharyngeal space throughout the apnoeic period. In elective surgery, THRIVE provides apnoea times as long as 60 minutes due to apnoeic oxygenation [ 1 ]. We report the first implementation of THRIVE with emergency patients into the ICU, ED and OR.

Key concepts: Medicine, Insufflation, Oxygenation, Rapid sequence induction, Hypoxemia, Anesthesia, Laryngoscopy, Emergency department

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Transnasal humidified rapid insufflation ventilatory exchange for pre-oxygenation and apnoeic oxygenation during rapid sequence induction — Research Paper | ScholarLens