BACKGROUND: Early postoperative atelectasis is common but often underdiagnosed complication that occurs in patients undergoing prolonged nonintubated anesthesia. Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) provides high-flow oxygen with mild positive pressure and may reduce the incidence of perioperative atelectasis. METHODS: In this single-center, single-blind randomized controlled trial, 128 patients who underwent endoscopic mucosal resection for multiple colorectal polyps were randomly assigned to receive THRIVE (Group T) or conventional facemask oxygen therapy (Group C). Lung ultrasound was performed before induction (T1) and immediately after the procedure (T2). The primary outcome was the incidence of early postoperative atelectasis confirmed by lung ultrasound; secondary outcomes included the modified lung ultrasound score (LUSS), intraoperative hypoxemia incidence, the postanesthesia care unit (PACU) length of stay, and endoscopist satisfaction. RESULTS: All 128 randomized patients completed the study. The overall incidence of postoperative atelectasis was 18.75%. Compared with patients receiving conventional facemask oxygen therapy, patients receiving THRIVE had a significantly lower incidence of atelectasis (10.94% vs. 26.56%, P = 0.013) and a lower postoperative LUSS at T2 (P = 0.019). THRIVE was also associated with a reduced incidence of intraoperative hypoxemia (0% vs. 10.94%, P = 0.016), a shorter PACU stay (25.00 min vs. 30.00 min, P < 0.001), and higher endoscopist satisfaction scores (P < 0.001). Multivariate analysis revealed that a longer recovery time was an independent risk factor for atelectasis (OR = 1.19, 95% CI: 1.03-1.39), whereas THRIVE was independently associated with a reduced risk of atelectasis (OR = 0.28, 95% CI: 0.08-0.85). CONCLUSION: THRIVE reduces the incidence of early postoperative atelectasis and the risk of intraoperative hypoxemia and shortens the PACU recovery time in patients undergoing prolonged nonintubated anesthesia. Moreover, it enhances endoscopist satisfaction. THRIVE demonstrated a favorable safety profile and modest benefits in this setting. Further studies are required before broader clinical application or expansion of indications can be established. TRIAL REGISTRATION: ClinicalTrials.gov (NCT06554678) URL: https://clinicaltrials.gov, registered on 12 August 2024. Retrospectively registered.
Song et al. (Wed,) studied this question.
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