{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T22:45:12Z","timestamp":1788821112826,"version":"build-2803163510"},"reference-count":14,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T00:00:00Z","timestamp":1592265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Microlaryngeal surgery typically requires oxygenation and ventilation via either an endotracheal tube (ETT), jet ventilation (JV), or intermittent apnea with an ETT. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) delivered by high flow nasal cannula has been reported as an alternative technique. This method of apneic oxygenation and ventilation allows for stable, unobstructed visualization of immobile laryngeal structures. We aim to describe the technique and characterize intraoperative parameters related to its safety.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Case Series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The electronic medical record was reviewed for patients who underwent microlaryngoscopy using THRIVE technique. Patient demographics, procedural details, operative parameters, and anesthesia records were reviewed. Descriptive statistics were reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 53 patients underwent microlaryngoscopy using THRIVE as the sole method of ventilation, with 62% female. Median age was 51\u2009years, and median BMI was 25\u2009kg\/m<jats:sup>2<\/jats:sup>. Most patients were ASA class 2, and most had a Mallampati score of 2. The most common surgical indications were subglottic stenosis, vocal fold lesions, and vocal fold paralysis. Median apnea time was 16\u2009minutes. At the end of case, median end tidal CO<jats:sub>2<\/jats:sub> was 50\u2009mmHg, and median minimum SpO<jats:sub>2<\/jats:sub> was 95. Six cases required supplementation of THRIVE with JV or tracheal intubation for sustained oxygen desaturation. There was an increase in end tidal CO<jats:sub>2<\/jats:sub> of 0.844\u2009mmHg\/min of apneic time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>THRIVE is a safe and effective technique for oxygenation and ventilation in microlaryngeal, non\u2010laser surgery in appropriately selected patients. To ensure safety, back\u2010up plans such as jet ventilation and microlaryngeal ETT should be available.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 131:587\u2013591, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.28776","type":"journal-article","created":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T09:40:40Z","timestamp":1592300440000},"page":"587-591","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Utility of Transnasal Humidified Rapid Insufflation Ventilatory Exchange for Microlaryngeal Surgery"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1908-397X","authenticated-orcid":false,"given":"Michael S.","family":"Benninger","sequence":"first","affiliation":[{"name":"Head and Neck Institute, Cleveland Clinic  Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4188-5063","authenticated-orcid":false,"given":"Emily S.","family":"Zhang","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine  Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Chen","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine  Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7371-9364","authenticated-orcid":false,"given":"William S.","family":"Tierney","sequence":"additional","affiliation":[{"name":"Head and Neck Institute, Cleveland Clinic  Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basem","family":"Abdelmalak","sequence":"additional","affiliation":[{"name":"Anesthesiology Institute, Cleveland Clinic  Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul C.","family":"Bryson","sequence":"additional","affiliation":[{"name":"Head and Neck Institute, Cleveland Clinic  Cleveland Ohio U.S.A."},{"name":"Cleveland Clinic Lerner College of Medicine  Cleveland Ohio U.S.A."},{"name":"Case Western Reserve University School of Medicine  Cleveland Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,16]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12923"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1959.14.1.97"},{"key":"e_1_2_6_4_1","first-page":"323","article-title":"Studies on diffusion respiration; changes in alveolar gases and pH of venous blood","volume":"6","author":"Draper WB","year":"1947","journal-title":"Fed Proc"},{"key":"e_1_2_6_5_1","first-page":"1","article-title":"Pulmonary uptake of oxygen, acid\u2010base metabolism, and circulation during prolonged apnoea","volume":"212","author":"Holmdahl MH","year":"1956","journal-title":"Acta Chir Scand Suppl"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14541"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13252"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aex036"},{"issue":"17","key":"e_1_2_6_9_1","first-page":"1","article-title":"The use of transnasal humidified rapid insufflation ventilatory exchange in laryngeal and pharyngeal surgery: flinders case series","volume":"2","author":"Huang L","year":"2019","journal-title":"Aust J Otolaryngol"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12921"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13408"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2018.11.009"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-019-02697-3"},{"issue":"22","key":"e_1_2_6_14_1","first-page":"1","article-title":"The use of THRIVE in otolaryngology: our experiences in two Australian tertiary facilities","volume":"2","author":"Lau J","year":"2019","journal-title":"Aust J Otolaryngol"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13873"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flary.28776","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.28776","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.28776","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.28776","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T16:27:47Z","timestamp":1693672067000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.28776"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,16]]},"references-count":14,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1002\/lary.28776"],"URL":"https:\/\/doi.org\/10.1002\/lary.28776","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,16]]},"assertion":[{"value":"2020-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}