Safety and Utility of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) for Laser Laryngeal Surgery

Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is gaining acceptance as a safe method for apneic ventilation and oxygenation during laryngeal procedures, but remains controversial during laser laryngeal surgery (LLS) due to the theoretical risk of airway fire. This study describes our experience with THRIVE during LLS.Retrospective cohort study.Stanford University Hospital, October 15, 2015 to June 1, 2021.Retrospective chart review of patients ≥18 years who underwent LLS involving the CO2 or KTP laser with THRIVE as the primary mode of oxygenation.A total of 172 cases were identified. 20.9% were obese (BMI ≥ 30). Most common operative indication was subglottic stenosis. The CO2 laser was used in 79.1% of cases. Median lowest intraoperative SpO2 was 96%. 44.7% cases were solely under THRIVE while 16.3% required a single intubation and 19.2% required multiple intubations. Mean apnea time for THRIVE only cases was 32.1 minutes and in cases requiring at least one intubation 24.0 minutes (p < .001). Mean apnea time was significantly lower for patients who were obese (p < .001) or had a diagnosis of hypertension (p = .016). Obese patients and patients with hypertension were 2.03 and 1.43 times more likely to require intraoperative intubation, respectively. There were no intraoperative complications or fires since the institution of our LLS safety protocol.By eliminating the fuel component of the fire triangle, THRIVE can be safely used for continuous delivery of high FiO2 during LLS, provided adherence to institutional THRIVE-LLS protocols.