Nasal Tse PAP -the next big thing in Anesthesiology

The Emergence of Nasal Tse-PAP 

     The tools available for the practice of Anesthesiology have been growing in number recently and it is now clear that the pace has been too fast for the Medical Profession to step up and adopt them. Such is the case with Nasal CPAP which I have renamed for Branding purposes as Nasal Tse-PAP in honour of Dr James Tse , who has been striving to teach the profession the great benefits of this technology. James has won important prizes and has greatly expanded the clinical experience with this technology.

     The contribution possible from nasal routes is being recognized by leaders in airway management thinking and might be summarized as falling into 4 general Groups in ascending order of effectiveness:

  1. Nasal Airway- alternate method of dealing with transient upper airway obstruction.

  2. Nasal Prongs- low flow transition for supplementary oxygen.

  3. HFNO - High Flow Nasal Oxygen -typified by the Vapotherm (R) which delivers 40 L/min or Optiflow(R) 1. which can deliver up to 70 L humidified oxygenated air to the pharynx via a nasal apparatus. This extremely effective strategy will save many lives by at once causing great turbulence , high oxygen availability for apnoeic Oxygenation, and a degree of CPAP.

4. Nasal TsePAP - this strategy promoted for many years by Dr James Tse from Rutger's University  has demonstrated the elegant and highly effective use of a Prediatric facemask , slightly modified , to generate nasal pressure as an induction strategy or as a rescue method. The ease of ventilation of a large range of patients (Obesity, Pediatric, Procedural MRI CT, and importantly as a transition to Intubation using a highly angled Video Laryngoscope like the GlideScope.

The advantages of this method include the use in bearded patients and use in patients having failed facemark ventilation. The nasal Tse PAP method pressurizes the nasal channels and tends to push the soft palate , tongue forward while delivering positive pressure and peep effects. This great work has been presented  at ASA, SAM, PGA, and internationally for many years. Patient safety Prize  has been awarded to Dr Tse for his work.

                CT Nasal Tse PAP in use - positive pressure can be added any time that the clinical situation requires it. The comfort of the apparatus is suited to long term application.

Dr Tse demonstrating the transition from Nasal Tse PAP to GlideScope intubation with out removal of the Nasal Tse PAP mask. The oxygenation continues at all stages of the procedure.

Nasal Tse Pap paediatric size 2 mask in place during care for a bearded patient cared for by Dr Tse at Robert Wood Johnson University Hospital. The ability to easily ventilate many patients with difficult face mask ventilation using a Nasal mask is important. The ability to deliver positive pressure easily ,as required , during procedures like MRI is also a good contribution to patient safety.

Nasal Tse PAP Apparatus - Dr James Tse - including attached oral CO2 monitor channel. Transition to positive pressure ventilation is done without changing the equipment and by preventing oral leakage of gas. 

Summary:
Nasal Strategies for ventilation are proven to add to patient safety and this has been recognized widely . Adoption has lagged and it is time that the Anesthesiology world quickly moved to catch up to the technical advances developed by Dr Tse and others.
Key Nasal rescue strategies are possible and are gaining recognition.


COI.
   I , as Glidescope Inventor and Consultant to Rutgers University must disclose a conflict of interest on this topic, having a minor interest in Nasal Tse PAP success.

1. Patel Anaesthesia 2015, 70, 323–329