Effect of high-flow nasal cannula oxygen therapy vs conventional oxygen therapy on adult postcardiothoracic operation

Wu, Xiu; Cao, Weijie; Zhang, Bin; Wang, Shengyu

doi:10.1097/md.0000000000012783

Cited by 20 publications

(16 citation statements)

References 39 publications

(49 reference statements)

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“…This conclusion was confirmed by a meta-analysis of 4 studies, which also reported that HFNC significantly reduced the incidence of pulmonary complications. 44 However, the results of our meta-analysis were not identical to these 2 meta-analyses. Our meta-analysis included 8 randomized controlled trials and a larger sample size.…”

Section: Discussioncontrasting

confidence: 74%

High-Flow Nasal Cannula vs Conventional Oxygen Therapy for Postcardiothoracic Surgery

Wang

Huang

et al. 2020

Respir Care

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BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy is widely used in extubated patients. We aim to evaluate the effect of HFNC compared with conventional oxygen therapy in adults after cardiothoracic surgery. METHODS: We conducted a literature search in PubMed, Embase, and ClinicalTrials for randomized controlled trials that compared HFNC with conventional oxygen therapy in extubated patients after cardiothoracic surgery. RESULTS: Eight studies with 1,086 subjects were included. Compared with conventional oxygen therapy, HFNC was associated with a significant reduction in the need for escalation of respiratory support (risk ratio 0.40, 95% CI 0.26-0.61, P < .001), re-intubation rate (risk ratio 0.35, 95% CI 0.13-0.96, P 5 .04), and length of hospital stay (mean difference-0.48, 95% CI-0.95 to-0.01, P 5 .05). No significant differences were found for the length of ICU stay (mean difference-0.09, 95% CI-0.21 to-0.04, P 5 .18), pulmonary complications (risk ratio 0.85, 95% CI 0.48-1.48, P 5 .56), or mortality rate (risk ratio 0.54, 95% CI 0.12-2.53, P 5 .44). CONCLUSIONS: HFNC may significantly reduce the need for the escalation of respiratory support and re-intubation rate, and might reduce the hospital stay. More high-quality randomized controlled trials are needed to further validate our results.

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Section: Discussioncontrasting

confidence: 74%

High-Flow Nasal Cannula vs Conventional Oxygen Therapy for Postcardiothoracic Surgery

Wang

Huang

et al. 2020

Respir Care

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“…Notwithstanding previous meta‐analyses published examining outcomes with HFNC compared with others forms of oxygen therapy in postoperative patients, our review, including the most recent study data, is the first to show improvements with HFNC strictly in all postoperative patients presenting with high risk for PCs. Of the previous reviews, two compared HFNC with COT in post‐extubation cardiac surgical patients which included two RCTs 39 or four RCTs, 40 respectively, and found reduction of the need for escalation of respiratory support compared with COT. These results were in accord with ours.…”

Section: Discussionmentioning

confidence: 99%

High flow nasal cannula versus conventional oxygen therapy in postoperative patients at high risk for pulmonary complications: A systematic review and meta‐analysis

Xiang

Xie

et al. 2020

Int J Clin Pract

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Background The effects of high flow nasal cannula (HFNC) on postoperative patients at high risk for pulmonary complications(PC) are controversial. We aimed to further determine the effectiveness of HFNC in postoperative patients at high risk for PC by comparison to conventional oxygen therapy (COT). Methods We performed a comprehensive search that compared HFNC with COT in postoperative patients at high risk for PC. The main outcomes were length of hospital stay (hospital LOS) and respiratory complications. Results Six trials with a total of 733 patients were pooled in our final studies. Except for Hospital LOS (I2 = 53%, χ2 = 8.51, P = .07) and rate of intubation or non‐invasive ventilation (NIV) for respiratory failure (RF) (I2 = 49%, χ2 = 1.97, P = .16) between HFNC and COT, no significant heterogeneity was found in outcome measures. Compared with COT, HFNC was associated with a lower rate of intubation or NIV for RF (RR 0.23, 95% CI 0.08‐0.66, P = .006) and rate of hypercapnia (RR 0.37, 95% CI 0.20‐0.68, P = .002). As for the Hospital LOS, ICU LOS, rate of requirement of O2 after discontinuous and hypoxemia, HFNC did not show any advantage over COT. Trial Sequential Analysis (TSA) for Hospital LOS showed that monitoring boundaries were finally not surpassed and required information size (RIS) was not met. Conclusions The available randomised controlled trials (RCTs) suggest that, among the postoperative patients at high risk for PC, HFNC therapy compared with the COT significantly reduces rate of incubation or NIV for RF and rate of hypercapnia, meanwhile is safely administered. Further large‐scale, multicenter, randomised and controlled studies are needed to confirm our results.

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“…[5][6][7] Because of these advantages, HFNC has been applied and has shown benefits in a number of clinical conditions, including hypoxemic respiratory failure, cardiogenic pulmonary edema, postoperation, and postextubation, and in subjects who have do-not-resuscitate (DNR) or do-not-intubate (DNI) orders. [8][9][10][11][12][13][14][15] In a recent large-scale study, HFNC was reported to decrease mortality in adult subjects with acute hypoxemic respiratory failure compared with noninvasive ventilation (NIV) and standard oxygen therapy. 16 However, in immunocompromised adult subjects with acute hypoxemic respiratory failure, there was no significant difference in mortality between HFNC and normal oxygen delivery.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Failure of High-Flow Nasal Cannula

Kim

et al. 2020

Respir Care

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BACKGROUND: The use of high-flow nasal cannula (HFNC) is rapidly increasing without clear indications, creating the potential for overuse or misuse and the accompanying risk of adverse events. The purpose of this study was to determine the factors associated with HFNC failure by examining the current clinical practice of HFNC. METHODS: From July 1, 2017, to June 30, 2018, in 5 university-affiliated hospitals in the Republic of Korea, a total of 1,161 admitted adult subjects who had HFNC administered were retrospectively enrolled and their medical records were reviewed. RESULTS: Pulmonary diseases including pneumonia (n 5 757, 65.2%) were the most common reason for use of HFNC. Subjects with do-not-resuscitate (DNR) or do-not-intubate (DNI) orders comprised 33.8% of the study population (n 5 392); 563 subjects (48.5%) were escalated directly to HFNC from low-flow devices without applying reservoir or other high-flow devices. In the non-DNR/DNI subjects, arterial blood gas was not monitored in 15.2% and 14.8% of subjects before and after HFNC application, respectively, and it was not monitored in 28.0% just before HFNC weaning. The HFNC failure rate was 27.0% in non-DNR/DNI subjects, and the HFNC failure was significantly associated with the decision by residents to apply HFNC (odds ratio [OR] 2.03, 95% CI 1.29-3.18, P 5 .002), high breathing frequency (OR 1.07, 95% CI 1.04-1.10, P < .001) 6 h before HFNC application, low S aO 2 (OR 0.92, 95% CI 0.89-0.95, P < .001)^6 h before HFNC application, low S pO 2 (OR 0.95, 95% CI 0.93-0.98, P < .001)^6 h before HFNC application, and the ratio of S pO 2 /F IO 2 to breathing frequency (ROX index)^6 h after HFNC application (OR 0.88, 95% CI 0.84-0.92, P < .001). CONCLUSIONS: HFNC was practiced without applying reservoir or other high-flow devices before application and without appropriate arterial blood gas monitoring during HFNC therapy. HFNC failure was significantly associated with the decision by the resident to use HFNC, breathing frequency, S aO 2 , and S pO 2^6 h before HFNC application, and with the ROX index^6 h after HFNC application.

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Effect of high-flow nasal cannula oxygen therapy vs conventional oxygen therapy on adult postcardiothoracic operation

Cited by 20 publications

References 39 publications

High-Flow Nasal Cannula vs Conventional Oxygen Therapy for Postcardiothoracic Surgery

High-Flow Nasal Cannula vs Conventional Oxygen Therapy for Postcardiothoracic Surgery

High flow nasal cannula versus conventional oxygen therapy in postoperative patients at high risk for pulmonary complications: A systematic review and meta‐analysis

Factors Associated With Failure of High-Flow Nasal Cannula

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