Use of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) to facilitate the management of subglottic stenosis in pregnancy

Abstract

Subglottic stenosis is a rare condition. Diagnosis is often delayed as symptoms are attributed to other causes, such as asthma. This problem may be compounded in pregnancy when dyspnoea may be attributed to normal physiological changes. In respiratory compromise, surgical intervention may be required and airway management is challenging as endotracheal intubation may be traumatic or, in severe cases, impossible.Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is a novel open-airway apnoeic technique using high-flow nasal oxygen. It does not expose the patient to the risks of jet ventilation, nor does it require the placement of an airway device to effectively oxygenate the patient. In pregnancy, elevation of maternal carbon dioxide is of particular concern as it may result in a worsening fetal acidosis. While THRIVE has been shown to provide some clearance of carbon dioxide, a patent airway is required for it to function effectively.In this case report we describe the management of a pregnant patient who underwent balloon dilatation for severe subglottic stenosis at 23 weeks’ gestation using THRIVE and we summarise the evidence supporting the use of this new technique in pregnant women.