Heated humidified high-flow nasal cannula oxygen after thoracic surgery — A randomized prospective clinical pilot trial

Brainard, Jason; Scott, Benjamin; Sullivan, Breandan; Fernandez-Bustamante, Ana; Piccoli, Jerome; Gebbink, Morris G.; Bartels, Karsten

doi:10.1016/j.jcrc.2017.04.023

Cited by 27 publications

(18 citation statements)

References 24 publications

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“…Firstly, only 4 trials are analyzed and sample is not too large in 2 trials (n < 110). [ 33 , 34 ] The ratio of sample between experimental group and control group in 2 trials is close to 1:1, and the design of control group is reasonable. The weight of these 2 studies is important in the meta-analysis.…”

Section: Discussionmentioning

confidence: 86%

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

Cao²,

Zhang³

et al. 2018

Medicine

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Introduction:The effect of high-flow nasal cannula (HFNC) on adult post cardiothoracic operation remains controversial. We conducted a meta-analysis of randomized controlled trials to evaluate the effect of HFNC and conventional oxygen therapy (COT) on postcardiothoracic surgery.Methods:A search was conducted in Embase, MEDLINE, Ovid, and Cochrane databases until December, 2017 for all the controlled study to compare HFNC with COT in adult postcardiothoracic surgery. Two authors extracted data and assessed the quality of each study independently. The meta-analysis was performed by using RevMan 5.3. The primary outcome was the rate of escalation of respiratory support rate and pulmonary complications; secondary outcome included the length of intensive care unit (ICU) stay and length of hospital stay and the rate of intubation.Results:Four studies that involved 649 patients were included in the analysis. No significant heterogeneity was found in outcome measures. Compared with COT, HFNC were associated with a significant reduction in the escalation of respiratory support (odds ratio [OR] = 0.44, 95% confidence interval [CI] = 0.29−0.66, P < .001) and pulmonary complications (OR = 0.28, 95% CI = 0.13−0.6, P = .001). There were no significant differences in the reintubation rate (OR = 0.33, 95% CI = 0.02−5.39, P = .43), length of ICU stay (weighted mean difference = 0.11; 95% CI = −0.44 −0.26, P = .14) or length of hospital stay (weighted mean difference = −0.15, 95% CI = −0.46 −0.17, P = .36) between the 2 groups. No severe complications were reported in either group.Conclusion:The HFNC could reduce respiratory support and pulmonary complications, and it could be safely administered for adult postcardiothoracic surgery. Further large-scale, randomized, and controlled trials are needed to update this finding.

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Section: Discussionmentioning

confidence: 86%

“…Two studies reported pulmonary complications, [ 33 , 34 ] such as atelectasis, suspected pneumonia, hypoxemia, and hypercapnia. There was significant difference in pulmonary complications between 2 groups (OR = 0.28, 95% CI = 0.13−0.6, P = .001, Fig.…”

Section: Resultsmentioning

confidence: 99%

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

Cao²,

Zhang³

et al. 2018

Medicine

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“…Ten trials [51][52][53][54][55][56][57][58][59][60] compared prophylactic HFNC to COT and only one trial compared HFNC to NIPPV [61]. Of these, six trials were conducted in patients following cardiac surgery [53,55,57,58], four trials were conducted following thoracic surgery [51,52,56], and one trial was performed in patients after major combined thoracic and abdominal surgery [54]. With the exception of blinding, all trials, except one [52], were judged to be at low or probably low risk of bias.…”

Section: Evidence Summarymentioning

confidence: 99%

“…Of these, six trials were conducted in patients following cardiac surgery [53,55,57,58], four trials were conducted following thoracic surgery [51,52,56], and one trial was performed in patients after major combined thoracic and abdominal surgery [54]. With the exception of blinding, all trials, except one [52], were judged to be at low or probably low risk of bias. One trial was judged to be at high risk of bias as it did not adhere to an intention-totreat analysis.…”

Section: Evidence Summarymentioning

confidence: 99%

The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline

et al. 2020

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Purpose High flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings. Methods We formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions. Results The guideline panel made a strong recommendation for HFNC in hypoxemic respiratory failure compared to conventional oxygen therapy (COT) (moderate certainty), a conditional recommendation for HFNC following extubation (moderate certainty), no recommendation regarding HFNC in the peri-intubation period (moderate certainty), and a conditional recommendation for postoperative HFNC in high risk and/or obese patients following cardiac or thoracic surgery (moderate certainty). Conclusions This clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians. Electronic supplementary material The online version of this article (10.1007/s00134-020-06312-y) contains supplementary material, which is available to authorized users.

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“…Finally, 8 articles met our inclusion criteria and were selected for data extraction, analysis, and quality assessment. [16][17][18][19][20][21][22][23] A flow chart of the search strategy and the reasons for exclusion are shown in Figure 1.…”

Section: Study Selectionmentioning

confidence: 99%

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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Heated humidified high-flow nasal cannula oxygen after thoracic surgery — A randomized prospective clinical pilot trial

Cited by 27 publications

References 24 publications

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

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

The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline

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

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