Safe Use of High-Flow Oxygenation During Transoral Laser Microsurgery Without Airway Fire: A Review of 369 Consecutive Cases.

Objective: Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is often avoided during intraoral laser use due to the concern for an airway fire with the addition of high-flow oxygen. We aim to demonstrate that THRIVE can be safely used during transoral laser microsurgery (TLM) without causing an airway fire or other major complications.

Study design: Retrospective cohort study.

Setting: Emory University Hospital Midtown between January 2020 and April 2024.

Methods: A retrospective chart review of all patients who underwent TLM with the use of THRIVE was performed. A standardized laser safety protocol was followed, and either a carbon dioxide or potassium titanyl phosphate laser was used for all cases.

Results: In total, 369 cases were examined, and no fire, ignition, flash, or major complication occurred. In total, 270 (73.2%) patients were Caucasian females and 271 (73.4%) patients had a primary diagnosis of idiopathic subglottic stenosis. A total of 110 (29.8%) cases were completed with the use of THRIVE alone, 238 (64.5%) required the addition of jet ventilation, and 21 (5.7%) required intubation for the completion of the case. Increased body mass index was positively associated with the need for jet ventilation or intubation and reached statistical significance for the type of airway management employed during the case (P-value < .001).

Conclusion: Airway fire and other major complications are preventable with the use of THRIVE during TLM if standardized laser safety practices are implemented.