High-Flow Therapy by Nasal Cannulae Versus High-Flow Face Mask in Severe Hypoxemia After Cardiac Surgery: A Single-Center Randomized Controlled Study—The HEART FLOW Study

Vourc’h, Mickaël; Nicolet, Johanna; Volteau, Christelle; Caubert, Laurene; Chabbert, C.; Lepoivre, Thierry; Sénage, Thomas; Roussel, Jean‐Christian; Rozec, Bertrand

doi:10.1053/j.jvca.2019.05.039

Cited by 18 publications

(23 citation statements)

References 33 publications

(42 reference statements)

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“…After this meta-analysis, 4 new RCTs on postsurgery subjects were published. 2,4,8,17 For post-cardiac surgery subjects, compared to O 2 therapy, the prophylactic use of HFNC after extubation was reported to improve oxygenation and reduce the need for NIV. 2 HFNC was also reported to reduce the ICU readmission and hospital length of stay in this population.…”

Section: Postextubation Subjectsmentioning

confidence: 99%

“…2,4,8,17 For post-cardiac surgery subjects, compared to O 2 therapy, the prophylactic use of HFNC after extubation was reported to improve oxygenation and reduce the need for NIV. 2 HFNC was also reported to reduce the ICU readmission and hospital length of stay in this population. 17 For obese subjects who underwent bariatric surgery, compared to O 2 therapy, the use of HFNC immediately after extubation significantly improved oxygenation within 3 h and reduced pulmonary complications during hospitalization.…”

Section: Postextubation Subjectsmentioning

confidence: 99%

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Year in Review 2019: High-Flow Nasal Cannula Oxygen Therapy for Adult Subjects

Jing

Scott

2020

Respir Care

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Section: Postextubation Subjectsmentioning

confidence: 99%

Section: Postextubation Subjectsmentioning

confidence: 99%

Year in Review 2019: High-Flow Nasal Cannula Oxygen Therapy for Adult Subjects

Jing

Scott

2020

Respir Care

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“…Therefore, HFNC may improve gas exchange and lung mechanics, reduce the respiratory rate and effort, and ameliorate dyspnea [ 12 , 13 , 14 ]. Possible HFNC-associated complications include nasal bleeding and mucus dryness, with occasional poor patient tolerance of the device [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Pulmonary complications predisposing sufferers to postextubation hypoxemia (e.g., atelectasis, pneumonia, pleural effusion, and pulmonary edema) may occur in up to 50% of cardiac surgery patients [ 15 , 19 , 20 , 21 , 22 ]. On the other hand, the optimal initial HFNC flow setting for postextubation respiratory support of hypoxemic cardiothoracic surgery patients is still unclear [ 1 , 2 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

High Flow Oxygen Therapy at Two Initial Flow Settings versus Conventional Oxygen Therapy in Cardiac Surgery Patients with Postextubation Hypoxemia: A Single-Center, Unblinded, Randomized, Controlled Trial

Theologou

Ischaki

Zakynthinos

et al. 2021

JCM

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In cardiac surgery patients with pre-extubation PaO2/inspired oxygen fraction (FiO2) < 200 mmHg, the possible benefits and optimal level of high-flow nasal cannula (HFNC) support are still unclear; therefore, we compared HFNC support with an initial gas flow of 60 or 40 L/min and conventional oxygen therapy. Ninety nine patients were randomly allocated (respective ratio: 1:1:1) to I = intervention group 1 (HFNC initial flow = 60 L/min, FiO2 = 0.6), intervention group 2 (HFNC initial flow = 40 L/min, FiO2 = 0.6), or control group (Venturi mask, FiO2 = 0.6). The primary outcome was occurrence of treatment failure. The baseline characteristics were similar. The hazard for treatment failure was lower in intervention group 1 vs. control (hazard ratio (HR): 0.11, 95% CI: 0.03–0.34) and intervention group 2 vs. control (HR: 0.30, 95% CI: 0.12–0.77). During follow-up, the probability of peripheral oxygen saturation (SpO2) > 92% and respiratory rate within 12–20 breaths/min was 2.4–3.9 times higher in intervention group 1 vs. the other 2 groups. There was no difference in PaO2/FiO2, patient comfort, intensive care unit or hospital stay, or clinical course complications or adverse events. In hypoxemic cardiac surgery patients, postextubation HFNC with an initial gas flow of 60 or 40 L/min resulted in less frequent treatment failure vs. conventional therapy. The results in terms of SpO2/respiratory rate targets favored an initial HFNC flow of 60 L/min.

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“…In this issue of the Journal of Cardiac and Vascular Anesthesia, Vourc'h et al report the results of the Heartflow randomized controlled trial, designed to test the hypothesis that high-flow nasal cannula (HFNC) compared with facemask oxygen improves oxygenation in adult patients after cardiac surgery. 1 After extubation, usual care in the intensive care unit (ICU) commonly includes low-flow oxygen, with the aim of preventing hypoxia. HFNC is an alternative treatment that provides an increased inspired oxygen fraction (FiO 2 ), humidifies inhaled gases, reduces air entrainment, washes out pharyngeal dead space, and may deliver modest positive end-expiratory pressure.…”

mentioning

confidence: 99%