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Updated: Jul 29, 2026
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Transnasal humidified rapid insufflation ventilatory exchange versus conventional facemask breathing for
Xiaoping Chen1,2, Chen Yang2, Yue Zhao2
1Clinical Medical College, Yangzhou University, Yangzhou, 225009, Jiangsu, China.
Objective:
To assess the effect of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) on regional cerebral oxygen saturation (rScO2) during general anesthesia induction in traumatic brain injury (TBI) emergency surgery.
Methods:
In this prospective randomized trial, 63 TBI patients undergoing emergency intracranial hematoma removal were allocated to conventional mask ventilation group (n = 32; 8 L/min O2, FiO2 1.00) or THRIVE group (n = 31; 30-50 L/min O2, FiO2 1.00). Outcomes included rScO2, PaO2, PaCO2, hypoxemia incidence (SpO2 < 95%), end-tidal CO2 (PETCO2), and Glasgow Outcome Scale (GOS) at discharge.
Results:
After 10-min preoxygenation, the THRIVE group exhibited higher rScO2 (surgical side: 70.9% ± 3.6% vs. 63.6% ± 2.8%; non-surgical: 79.1% ± 1.6% vs. 71.2% ± 2.7%; P < 0.01), increased PaO2 (450.23 ± 60.99 vs. 264.88 ± 49.33 mmHg), and reduced PaCO2 (37.81 ± 3.65 vs. 43.59 ± 3.76 mmHg; P < 0.01). During tracheal intubation, hypoxemia events, defined as SpO2 < 95%, occurred in 0/31 patients (0%) in the THRIVE group versus 9/32 patients (28.1%) in the conventional ventilation group (P < 0.01). PETCO2 post-intubation was lower in the THRIVE group (43.10 ± 2.66 vs. 49.22 ± 3.31 mmHg; P < 0.01). Patients receiving THRIVE had a higher proportion of good neurological outcomes (GOS > 3: 35.5% vs. P < 0.05). ICU/hospital stay and gastric antrum cross-sectional area showed no intergroup differences.
Conclusion:
THRIVE could significantly increase rScO2 during anesthesia induction in TBI emergency surgery patients and improve their neurological functional prognosis. Trial registration retrospectively registered; Chinese Clinical Trial Registry, www.chictr.org.cn, number ChiCTR 2300073951: Registered on June 26.2023.
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