High-flow nasal oxygen combined with jet ventilation for tubeless microlaryngoscopic vocal fold polyp surgery: A randomised controlled trial.

BACKGROUND AND AIMS: Tubeless microlaryngoscopic surgery provides an unobstructed operative field, but carbon dioxide accumulation remains a concern during apnoea. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) maintains oxygenation but has limited capacity for carbon dioxide clearance. This study compared THRIVE combined with jet ventilation with THRIVE alone during tubeless vocal fold polyp surgery. METHODS: In this single-blind randomised controlled trial, 100 adults undergoing microlaryngoscopic vocal fold polyp surgery were allocated to THRIVE alone (Group T) or THRIVE combined with jet ventilation (Group M). The primary endpoint was the change in transcutaneous carbon dioxide partial pressure (ΔPtcCO2) from the onset of apnoea to the end of surgery. Oxygenation, adverse events, conversion to tracheal intubation, and recovery characteristics were also assessed. RESULTS: Compared with Group T, patients in Group M showed a markedly smaller ΔPtcCO2 (-0.56 ± 2.74 vs 10.98 ± 5.41 ± 5.41 mmHg; P < 0.001) and a lower end-of-surgery PtcCO2 (36.42 ± 2.13 vs 47.02 ± 6.16 mmHg; P < 0.001). Mild oxygen desaturation occurred more frequently in Group T than in Group M [7/50 (14%) vs 0/50 (0%); P = 0.019], whereas no patient in either group developed hypoxaemia or required tracheal intubation. CONCLUSION: Adding jet ventilation to THRIVE reduced intraoperative carbon dioxide accumulation during tubeless microlaryngoscopic vocal fold polyp surgery without increasing perioperative adverse events.