Biomarkers for oxidative stress and organ injury during Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange compared to mechanical ventilation in adults undergoing microlaryngoscopy: A randomised controlled study

• Published in: Acta anaesthesiologica Scandinavica 2021-10, Vol.65 (9), p.1276-1284
• Main Authors: Forsberg, Ida‐Maria, Mkrtchian, Souren, Ebberyd, Anette, Ullman, Johan, Eriksson, Lars I., Lodenius, Åse, Jonsson Fagerlund, Malin
• Format: Article
• Language: English
• Subjects: airway management; Anesthesia; Apnea; apnoeic oxygenation; Biomarkers; Calcium-binding protein; Creatinine; General anesthesia; Heart; high‐flow nasal oxygen; Hypercapnia; Hyperoxia; Inflammation; Inflammatory response; Intubation; Malondialdehyde; Mechanical ventilation; Medicin och hälsovetenskap; Organs; Oxidative stress; Oxygenation; S100b protein; Surgery; THRIVE; Troponin; Ventilation
• ISSN: 0001-5172; 1399-6576; 1399-6576
• DOI: 10.1111/aas.13927

Background Apnoeic oxygenation using Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) during general anaesthesia prolongs the safe apnoeic period. However, there is a gap of knowledge how THRIVE‐induced hyperoxia and hypercapnia impact vital organs. The primary aim of this randomised controlled trial was to characterise oxidative stress and, secondary, vital organ function biomarkers during THRIVE compared to mechanical ventilation (MV). Methods Thirty adult patients, American Society of Anesthesiologists (ASA) 1–2, undergoing short laryngeal surgery under general anaesthesia were randomised to THRIVE, FIO2 1.0, 70 L min−1 during apnoea or MV. Blood biomarkers for oxidative stress, malondialdehyde and TAC and vital organ function were collected (A) preoperatively, (B) at procedure completion and (C) at PACU discharge. Results Mean apnoea time was 17.9 (4.8) min and intubation to end‐of‐surgery time was 28.1 (12.8) min in the THRIVE and MV group, respectively. Malondialdehyde increased from 11.2 (3.1) to 12.7 (3.1) µM (P = .02) and from 9.5 (2.2) to 11.6 (2.6) µM (P = .003) (A to C) in the THRIVE and MV group, respectively. S100B increased from 0.05 (0.02) to 0.06 (0.02) µg L−1 (P = .005) (A to C) in the THRIVE group. No increase in TAC, CRP, leukocyte count, troponin‐T, NTproBNP, creatinine, eGFRcrea or NSE was demonstrated during THRIVE. Conclusion While THRIVE and MV was associated with increased oxidative stress, we found no change in cardiac, inflammation or kidney biomarkers during THRIVE. Further evaluation of stress and inflammatory response and cerebral and cardiac function during THRIVE is needed.