Early nasal high-flow versus Venturi mask oxygen therapy after lung resection: a randomized trial

Abstract

Background Data on high-flow nasal oxygen after thoracic surgery are limited and confined to the comparison with low-flow oxygen. Different from low-flow oxygen, Venturi masks provide higher gas flow at a predetermined fraction of inspired oxygen (FiO 2 ). We conducted a randomized trial to determine whether preemptive high-flow nasal oxygen reduces the incidence of postoperative hypoxemia after lung resection, as compared to Venturi mask oxygen therapy. Methods In this single-center, randomized trial conducted in a teaching hospital in Italy, consecutive adult patients undergoing thoracotomic lung resection, who were not on long-term oxygen therapy, were randomly assigned to receive high-flow nasal or Venturi mask oxygen after extubation continuously for two postoperative days. The primary outcome was the incidence of postoperative hypoxemia (i.e., ratio of the partial pressure of arterial oxygen to FiO 2 (PaO 2 /FiO 2 ) lower than 300 mmHg) within four postoperative days. Results Between September 2015 and April 2018, 96 patients were enrolled; 95 patients were analyzed (47 in high-flow group and 48 in Venturi mask group). In both groups, 38 patients (81% in the high-flow group and 79% in the Venturi mask group) developed postoperative hypoxemia, with an unadjusted odds ratio (OR) for the high-flow group of 1.11 [95% confidence interval (CI) 0.41–3] ( p = 0.84). No inter-group differences were found in the degree of dyspnea nor in the proportion of patients needing oxygen therapy after treatment discontinuation (OR 1.34 [95% CI 0.60–3]), experiencing pulmonary complications (OR 1.29 [95% CI 0.51–3.25]) or requiring ventilatory support (OR 0.67 [95% CI 0.11–4.18]). Post hoc analyses revealed that PaO 2 /FiO 2 during the study was not different between groups ( p = 0.92), but patients receiving high-flow nasal oxygen had lower arterial pressure of carbon dioxide, with a mean inter-group difference of 2 mmHg [95% CI 0.5–3.4] ( p = 0.009), and were burdened by a lower risk of postoperative hypercapnia (adjusted OR 0.18 [95% CI 0.06–0.54], p = 0.002). Conclusions When compared to Venturi mask after thoracotomic lung resection, preemptive high-flow nasal oxygen did not reduce the incidence of postoperative hypoxemia nor improved other analyzed outcomes. Further adequately powered investigations in this setting are warranted to establish whether high-flow nasal oxygen may yield clinical benefit on carbon dioxide clearance. Trial registration ClinicalTrials.gov, NCT02544477 . Registered 9 September 2015. Electronic supplementary material The online version of this artic...

High-Flow Nasal Cannula After Surgery–A Lateral Move From Conventional Oxygen Therapy?

“…The nonsuperiority of HFNC over standard oxygen therapy in postoperative subjects reported by Gaspari et al 1 is in agreement with the results of similar studies, which included subjects who had undergone major abdominal surgery, 2 lung resection, 3 or cardiac surgery (both obese 4 and normal weight) subjects. 5 Based on this and previous studies, can we state that HFNC should not be used in postoperative patients?…”

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

“…For subjects who underwent lung resection, there was no significant difference of postoperative hypoxemia, respiratory failure, or pulmonary complications between HFNC and air-entrainment mask groups. 8 These findings are also contradictory to the results of a study that compared HFNC with O 2 therapy for subjects after thoracoscopic lobectomy, in which HFNC was shown to reduce the risk of re-intubation. 38 Future studies on the use of HFNC for postsurgical subjects with considerations regarding specific type of surgery and outcomes are needed.…”

“…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.…”

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

“…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.…”