Total Lung Lavage using THRIVE for Pre-oxygenation and Oxygen Insufflation During Intubation: Our Initial Experience of Two Cases

Vol 6 | Issue 3 | September-December 2020 | Page 11-13 | Vaibhavi V. Baxi, Mansimran K. Kulaar, Aarti Kulkarni

Author: Vaibhavi V. Baxi [1], Mansimran K. Kulaar [1], Aarti Kulkarni [1]

[1] Department of Anaesthesia, Lilavati Hospital And Research Centre, Mumbai, Maharashtra, India

Address of Correspondence
Dr. Vaibhavi V. Baxi,
Consultant Anesthetist, Lilavati Hospital and Research Centre, Bandra west, Mumbai, Maharshtra, India.

Total Lung Lavage using THRIVE for Pre-oxygenation and Oxygen Insufflation During Intubation: Our Initial Experience of Two Cases


Introduction: Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by deposition of lipoproteinaceous material in the alveoli secondary to abnormal processing of surfactant by macrophages. Total-lung lavage (TLL); a gold standard management for this disease entails washing out the proteinaceous material from the alveoli and re-establish effective oxygenation and ventilation. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE), utilizes apnoeic oxygenation to extend the apnoeic window and delay rapid de-saturation common in these cases; thus allowing for safer intubation. We would like to share our experience of two cases of TLL for PAP in which we used THRIVE for pre-oxygenation and apnoeic oxygenation during intubation. To our knowledge this is the first case report demonstrating the use of THRIVE in a case of TLL in literature.
Case presentation: We had two patients posted for TLL who were suffering from PAP; both had presented with breathlessness of increasing severity over the last few months. Both patients were young (35 & 40 yrs old) and had no other co-morbidities. Their baseline oxygen saturations (SpO2) and partial pressure of oxygen in blood (pO2) on air were on the lower side. Hence the decision was taken to pre-oxygenate them using THRIVE and to also use THRIVE during intubation to improve their tolerance to apnoea during intubation.
Conclusion: When used for pre-oxygenation and oxygen insufflation during intubation THRIVE prolongs the tolerable apnoea time and delays de-saturation during intubation.
Keywords: Pulmonary alveolar proteinosis (PAP), Total Lung Lavage (TLL), Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE).


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How to Cite this Article: Baxi VV, Kulaar MK, Kulkarni A | Total Lung Lavage using THRIVE for Pre-oxygenation and Oxygen Insufflation During Intubation: Our Initial Experience of Two Cases | Journal
of Anaesthesia and Critical Care Case Reports | September-December 2020; 6(3): 11-13.

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