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Skip to 0 minutes and 11 seconds [PRODUCING STRIDOR] When did you have your radiotherapy and chemotherapy for your oesophogeal cancer? Finished on the 31st of August. Which was about about two months ago. Yeah. OK. And how long has the breathing been bad like this for? 2, 3 days. Can you swallow at all? I can swallow like that. I’m not allowed to swallow any food or liquid.

Skip to 0 minutes and 42 seconds Can you lie flat at all? Dunno, haven’t tried. How’s your breathing now? Getting better. Getting better. Is it better with that on or without it? With.

Skip to 0 minutes and 57 seconds So this is quite tight. And there are two aspects of this. This lower airway, there’s a small airway there. And there’s an airway there. We think that this area here is false cord swelling. We are about nine or ten minutes into the procedure, and the saturations are still 100. [PRODUCING STRIDOR] There’s obvious stridor. So you’ve got subglottic stenosis. And you have been short of breath for quite a while. How bad is the stridor at the moment? My daughter thinks it’s quite bad.

Skip to 1 minute and 38 seconds Which is more comfortable, breathing with this on or without it on? Which one do you think is more comfortable? With this. With this. So you feel more comfortable with the breathing? Yeah. It seems it softens it somehow. Softens it. Yeah. I don’t know how you would explain it. OK. But it’s interesting, because when you’re speaking, there’s no stridor coming through. So that’s just the pneumatic pneumatic splint effect happening.

Skip to 2 minutes and 5 seconds Undertaking laryngoscopy, we are about to spray her very abnormal stridorous slit-like airway, and hence her stridor. She’s still being THRIVED. She’s gone up to 70 litres per minute. She’s on a propofol infusion. And her saturations are 99%. And that is after about 10 minutes of apnoea.

Skip to 2 minutes and 37 seconds No resistance, no resistance. Might be a bit of resistance now. Rotate the tube.

Skip to 2 minutes and 47 seconds OK. OK, so it’s definitely dropped– there we go. Push it in a bit more, bit more, bit more, keep going, that’s it.

Skip to 2 minutes and 57 seconds OK, that’s going with no resistance. OK, just stop there.

Skip to 3 minutes and 7 seconds Now, how much do you think that is Khalid, how many millimetres? 3 to 4. 3 to 4 millimetres.

Skip to 3 minutes and 24 seconds So here we are, 3 to 4 millimetre airway.

Skip to 3 minutes and 37 seconds Sats are 97.

Skip to 3 minutes and 41 seconds Go ahead and keep it spinning. Just move the thing that’s right over the screen backwards. That’s it. That’s good. So that’s THRIVE. That’s the supraglottic flow vortices You see that? Yeah? Suction, please. Ready to come out.

Skip to 4 minutes and 5 seconds OK, let’s do the other side.

Skip to 4 minutes and 11 seconds Professor Rubin’s putting a rigid bronchoscope down. What we’re seeing is the paralysed patient with paralysed vocal cords, as in paralysed from muscle relaxants. Then as we go through, we will see a movement that takes place as a consequence of cardiogenic movements. So that’s mediastinal movements in a paralysed patient. And you can see that all the way down to carina You can see, you can actually see tracheal being pushed in and out, can’t you? That’s really helpful, John. And then if we come back, you can see movement’s taking place. And that superimposed on the supraglottic flow vortices is the mechanism by which CO2 is cleared and oxygenation enhanced during THRIVE.

Skip to 5 minutes and 15 seconds So this is high-flow carinal flow with Hunsaker. Same patient with no THRIVE and carinal Hunsaker. Exactly the same patient. So the CO2 is higher, significantly higher.

HFNO in Action

In this video, Dr Anil Patel demonstrates the uses of High-Flow Nasal Oxygenation and Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE).

As you read in the previous article, HFNO can be very useful to relieve airway obstruction and, in the form of THRIVE, to provide apnoeic oxygenation during shared-airways procedures and attempts at intubation.

In the video the physiological principles of supraglottic vortices and cardiac oscillation are illustrated.

HFNO can also used to oxygenate patients during awake tracheal intubation: move onto the next step to learn more about this technique.

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This video is from the free online course:

Airway Matters

UCL (University College London)