Journal of Anaesthesia & Critical Care Case Reports

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.
E-mail: drvaibhavi13@gmail.com

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

Abstract

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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