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Updated: Dec 26, 2025

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Transnasal humidified rapid insufflation ventilatory exchange during bronchoscopy in severe pulmonary hypertension
Lucas Upperman1, Thomas Gildea2, Ursula Galway1
1Department of Anesthesiology Cleveland Clinic Foundation Cleveland OH USA.
Abstract:
Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) has been shown to prevent desaturation and prolong apnoeic time in the perioperative setting. Previously, pulmonary hypertension was not studied using this technique, due to concern for hypercapnia and resultant transient worsening of mean pulmonary artery pressure. We describe a patient with severe pulmonary hypertension (mean pulmonary artery pressure of 82 mmHg) who underwent bronchoscopy using deep sedation with THRIVE. There were no recorded desaturation events and no post-operative signs of hypercapnia. This case report demonstrates a novel use of THRIVE in a patient with severe pulmonary hypertension.
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