Comparison of High-flow Nasal Cannula (HFNC) and Conventional Oxygen Therapy in Obese Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis

Wang, Yanli; Zhu, Jinkui; Wang, Xiufeng; Liu, N A; Yang, Qiaoyun; Luan, Guoan; Ma, Xinhui; Liu, Juan

doi:10.21873/invivo.12533

Cited by 12 publications

(13 citation statements)

References 33 publications

(50 reference statements)

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“…Despite the recommendation of oxygen supplementation in patients at high risk of postoperative atelectasis 43 , we found that the use of HFNO was unable to improve oxygenation parameters in patients with obesity both during the periprocedural period and at three hours after surgery. Consistent with our findings, another meta-analysis investigating patients with obesity undergoing cardiac surgery demonstrated no significant improvements in atelectasis score, dyspnea score, PaO 2 /FiO 2 ratio, and reintubation rate in patients receiving HFNO compared with those undergoing COT 44 . The lack of benefits of HFNO in patients with obesity during the postoperative period underscores the need for timely intervention (e.g., reintubation) in case of respiratory distress after tracheal extubation.…”

Section: Discussionsupporting

confidence: 90%

Efficacy of high-flow nasal oxygenation against peri- and post-procedural hypoxemia in patients with obesity: a meta-analysis of randomized controlled trials

Hung

Chang

et al. 2022

Sci Rep

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This meta-analysis aimed at investigating the efficacy of high-flow nasal oxygenation (HFNO) against hypoxemia in patients with obesity compared with conventional oxygenation therapy and non-invasive ventilation. Databases were searched from inception to August 2021. Studies involving peri- or post-procedural use of HFNO were included. The primary outcome was risk of hypoxemia, while the secondary outcomes included status of oxygenation and carbon dioxide elimination. Ten randomized controlled trials (RCTs) were included. We found that HFNO prolonged the safe apnea time at induction compared to control group [mean difference (MD) = 73.88 s, p = 0.0004; 2 RCTs] with no difference in risk of peri-procedural hypoxemia [relative risk (RR) = 0.91, p = 0.64; 4 RCTs], minimum SpO2 (MD = 0.09%, p = 0.95; 4 RCTs), PaO2 (MD = − 8.13 mmHg, p = 0.86; 3 RCTs), PaCO2 (MD = − 6.71%, p = 0.2; 2 RCTs), EtCO2 (MD = − 0.28 mmHg, p = 0.8; 4 RCTs) between the two groups. HFNO also did not improve postprocedural PaO2/FiO2 ratio (MD = 41.76, p = 0.58; 2 RCTs) and PaCO2 (MD = − 2.68 mmHg, p = 0.07; 2 RCTs). This meta-analysis demonstrated that the use of HFNO may be associated with a longer safe apnea time without beneficial impact on the risk of hypoxemia, oxygenation, and CO2 elimination in patients with obesity. The limited number of trials warranted further large-scale studies to support our findings.

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Section: Discussionsupporting

confidence: 90%

Efficacy of high-flow nasal oxygenation against peri- and post-procedural hypoxemia in patients with obesity: a meta-analysis of randomized controlled trials

Hung

Chang

et al. 2022

Sci Rep

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“…[16] In surgical discipline, HFNC can maintain patients' oxygenation in cardiac surgery. [17] There are some limitations of our study. First of all, the retrospective study design inevitably inherited some select bias.…”

Section: Discussionmentioning

confidence: 91%

Clinical outcomes of high-flow nasal cannula oxygen therapy in acute heart failure patients with hypoxemia: A retrospective cohort study

Tong

Yao

et al. 2022

Medicine

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Acute heart failure (AHF) is life-threatening medical condition requiring hospital admission and appropriate oxygen therapy. High flow nasal cannula oxygen therapy (HFNC) has gained its popularity in treatment of AHF, however, there were less studies have demonstrated the physiological efficacy of HFNC. Purpose of this study was to evaluated the physiological responses and clinical outcomes of HFNC by comparing with noninvasive positive pressure ventilation (NPPV) therapy. A retrospective cohort investigation was conducted at emergency intensive care unit (EICU) and cardiovascular center of our hospital from June 2019 to March 2022, AHF patients with hypoxemia were reviewed. According to the received oxygen therapy model, patients were divided into HFNC and NPPV groups. Demographic data, arterial blood gas (ABG) parameter, echocardiography findings, complications and other related variables were extracted and collected from the electronic medical records (EMRs) by well-trained investigators. Physiological responses and clinical outcomes within and between 2 groups were analyzed. Finally, 156 patients with a mean age of 69.3 ± 7.1 years were reviewed, there were 82 (52.6%) male and 74 (47.4%) female patients in the sample and 70 (44.9%) and 86 (55.1%) patients classified III and IV score were included in this study, 80 patients received HFNC and 76 underwent NPPV oxygen therapy. There were no significant differences of baseline characteristics for the 2 groups patients. Changes of left ventricular function parameters, ABG and clinical outcomes were all improved satisfactorily after 24 h medical interventions in both group, what's more, patients underwent HFNC therapy could acquire a better amelioration when compared with NPPV groups (P < .05). HFNC may be an ideal model for patients with AHF, particularly those with hypoxemia. HFNC therapy could significantly improve several objective parameters of physiological responses and clinical outcomes. Abbreviations: ABG = arterial blood gas, AHF = acute heart failure, APACHE II = physiology and chronic health evaluation-II, FiO 2 = inspired oxygen concentration, HF = heart failure, HFNC = high flow nasal cannula, HR = heart rate, LVEDV = left ventricular end diastolic volume, LVEF = left ventricular ejection fraction, LVESD = left ventricular and systolic diameter, LVESV = left ventricular end systolic volume, NPPV = noninvasive positive pressure ventilation, NT-proBNP = N-terminal pro-B-type natriuretic peptide, PaO 2 = arterial partial pressure of oxygen, RR = respiratory rate, SpO 2 = blood oxygen saturation.

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“…Hung's study showed HFNC might prolong the safe apnea time, but did not improve oxygenation compared to COT or NIV in obese patients during the peri- and postprocedural period [ 7 ]. Another study involving 3 trials also showed that there was no significant advantages of improving oxygenation in HFNC compared to the COT group in obese patients who underwent cardiac surgery [ 25 ]. Nevertheless, due to limited trials being included in previous studies, the conclusion might be controversial in obese patients.…”

Section: Discussionmentioning

confidence: 99%

Section: Comparison With Previous Meta-analysesmentioning

confidence: 99%

“…Previous meta-analyses assessing the e cacy of HFNC in varied clinical scenarios have been published, including patients with acute respiratory failure, COPD, obesity, and patients with planned extubation in ICU [7,[24][25][26][27]. Of these studies, only two studies explored the application of HFNC in obese patients [7,25]. Hung's study showed HFNC might prolong the safe apnea time, but did not improve oxygenation compared to COT or NIV in obese patients during the periand postprocedural period [7].…”

Section: Comparison With Previous Meta-analysesmentioning

confidence: 99%

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Efficacy of High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Obese Patients during the Perioperative Period: A Systematic Review and Meta-Analysis

Zhou

Wang

2022

Canadian Respiratory Journal

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Background. Obesity is a risk factor for severe airway obstruction and hypoxemia. High-flow nasal cannula (HFNC) is considered as a novel method for oxygen therapy, but the efficacy of HFNC for obese patients is controversial. This meta-analysis aimed to assess the efficacy of HFNC compared with conventional oxygen therapy (COT) in obese patients during the perioperative period. Methods. We searched the PubMed, Embase, Web of Science, the Cochrane Library, and Google scholar databases for randomized controlled trials (RCTs) that compared the efficacy of HFNC with COT in obese patients during the perioperative period. The primary outcome was the incidence of hypoxemia, while the secondary outcomes included the lowest SpO2, the need for additional respiratory support, and the hospital length of stay (LOS). Results. Twelve trials with 798 obese patients during the perioperative period were included. Compared with COT, HFNC reduced the incidence of hypoxemia (RR, 0.60; 95% CI, 0.43 to 0.83; P = 0.002 ; I2 = 24%; 8 RCTs; n = 458), increased the lowest SpO2 (MD, 2.88; 95% CI, 1.53 to 4.22; P < 0.0001 ; I2 = 32%; 5 RCTs; n = 264), decreased the need for additional respiratory support (RR, 0.43; 95% CI, 0.21 to 0.88; P = 0.02 ; I2 = 0%; 3 RCTs; n = 305), and shortened the hospital LOS (MD, −0.31; 95% CI, −0.57 to −0.04; P = 0.02 ; I2 = 0%; 3 RCTs; n = 214). Conclusions. This meta-analysis showed that compared with COT, the use of HFNC was able to reduce the incidence of hypoxemia, increase the lowest SpO2, decrease the need for additional respiratory support, and shorten the hospital LOS in obese patients during the perioperative period. Well-organized trials with large sample size should be conducted to support our findings.

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Comparison of High-flow Nasal Cannula (HFNC) and Conventional Oxygen Therapy in Obese Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis

Cited by 12 publications

References 33 publications

Efficacy of high-flow nasal oxygenation against peri- and post-procedural hypoxemia in patients with obesity: a meta-analysis of randomized controlled trials

Efficacy of high-flow nasal oxygenation against peri- and post-procedural hypoxemia in patients with obesity: a meta-analysis of randomized controlled trials

Clinical outcomes of high-flow nasal cannula oxygen therapy in acute heart failure patients with hypoxemia: A retrospective cohort study

Efficacy of High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Obese Patients during the Perioperative Period: A Systematic Review and Meta-Analysis

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