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Updated: Jul 20, 2025
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Addressing desaturation in a tracheal stenosis patient using the transnasal humidified rapid-insufflation ventilatory
Sou Hyun Lee1, Eunyoung Cho, Ji Hoon Park
1Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.
Rationale:
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is used in tracheostomy but not in cases of airway obstruction. This case report explores the use of THRIVE for managing airway obstruction during tracheostomy in patients with subglottic and tracheal stenosis, thereby addressing the current knowledge gap and exploring its potential for airway management.
Patient Concerns:
A 63-year-old female with subglottic and tracheal stenoses underwent tracheostomy. Multiple attempts to establish a patent airway were unsuccessful, and oxygen saturation dropped to 56%.
Diagnosis:
Endotracheal tube was directed toward the tracheal wall, causing airway obstruction.
Interventions:
THRIVE was administered to the patient. Subsequently, the tube position was adjusted to enhance ventilation.
Outcomes:
The patient's oxygen saturation increased to 99%. The postoperative complications, including subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumopericardium, resolved. The patient was discharged on postoperative day 9.
Lessons:
THRIVE could be considered a temporary measure to enhance oxygenation before initiating a definitive treatment strategy.
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