Use of THRIVE in Theatre (603)

Warning

exp date isn't null, but text field is

A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Introduction

THRIVE™ is used to improve pre-oxygenation and prolong the apnoeic period prior to establishing a definitive airway.

THRIVE™ equipment should be used as an alternative to conventional pre-oxygenation.

In cases where THRIVE™ cannot be used, a NODESAT (Nasal Oxygen During Efforts Securing A Tube) approach with nasal cannula should be considered.

Airway Management

IN ALL CASES there must be A PLAN FOR AIRWAY MANAGEMENT and A BACKUP PLAN FOR FAILURE. This MUST BE AGREED BEFORE INDUCTION.

THRIVE™ is an adjunct. IT IS NOT A SUBSTITUTE FOR DEFINITIVE AIRWAY MANAGEMENT.

A CONSULTANT ANAESTHETIST MUST BE PRESENT OR ON ROUTE TO THE HOSPITAL.

Acceptable Uses

  • Morbid obesity (BMI>45 kg/m2)
  • Hypoxia in a critically ill patient with reversible pathology
  • Difficulty anticipated with airway management
  • Patient established on high flow oxygen in ICU/HDU
  • Airway surgery (especially to facilitate a ‘tubeless field’)

Contraindications

  • Epistaxis
  • Base of skull fracture suspected or demonstrated
  • THRIVE™ is an aerosol generating procedure and appropriate precautions must be taken

References

1. Patel A, Nouraei SAR. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia 2015; 70: 323–9
2. Badiger S, John M, Fearnley RA and Ahmad I. Optimizing oxygenation and intubation conditions during awake fibre-optic intubation using a high-flow nasal oxygen-delivery system. Br. J. Anaesth. 2015; 115: 629-32
3. Ramachandran SK, Cosnowski A, Shanks A, et al. Apneic oxygenation during prolonged laryngoscopy in obese patients: arandomized, controlled trial of nasal oxygen administration. J Clin Anesth. 2010; 22: 164–8
4. Sud A, Patel A. THRIVE: five years on and into the COVID-19 era. Br. J. Anaesth. 2021; 126: 768-733

Last reviewed: 30 March 2022

Next review: 30 March 2023

Author(s): Stewart Milne

Version: 3

Approved By: Anaesthesia Cross Sector Governance Group

Document Id: 603