Effect of early postextubation high-flow nasal cannula vs conventional oxygen therapy on hypoxaemia in patients after major abdominal surgery: a French multicentre randomised controlled trial (OPERA)

Futier, Emmanuel; Paugam–Burtz, Catherine; Godet, Thomas; Khoy-Ear, Linda; Rozencwajg, Sacha; Delay, J; Verzilli, Daniel; Dupuis, Jeremie; Chanques, Gérald; Bazin, Jean-Étienne; Constantin, Jean-Michel; Pereira, Bruno; Jaber, Samir

doi:10.1007/s00134-016-4594-y

Cited by 165 publications

(172 citation statements)

References 29 publications

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“…It has been reported to improve oxygenation after extubation in infants [12]. One clinical study indicated that HFNC might have benefit in patients with abdominal surgery [13]. However, after two years of research, they failed to identify beneficial effect of HFNC therapy after extubation in terms of the reduction of either reintubation or NIV application.…”

Section: Discussionmentioning

confidence: 99%

Effect of High-Flow Nasal Cannula versus Conventional Oxygen Therapy for Patients with Thoracoscopic Lobectomy after Extubation

Qian

Liu³

et al. 2017

Canadian Respiratory Journal

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Objective. To investigate whether high-flow nasal cannula (HFNC) oxygen therapy is superior to conventional oxygen therapy for reducing hypoxemia and postoperative pulmonary complications (PPC) in patients with thoracoscopic lobectomy after extubation. Methods. Patients with intermediate to high risk for PPC were enrolled in this study. Subjects were randomly assigned to HFNC group (HFNCG) or conventional oxygen group (COG) following extubation. Arterial blood samples were collected after extubation at 1, 2, 6, 12, 24, 48, and 72 h. Patients with postoperative hypoxemia and PPC were recorded. Adverse events were also documented. Results. Totally 110 patients were randomly assigned to HFNCG (n = 56) and COG (n = 54). The occurrence rate of hypoxemia in COG was twice more than that in HFNCG (29.62% versus 12.51%, P < 0.05) and PaO2, PaO2/FiO2, and SaO2/FiO2 were significantly improved in HFNCG (P < 0.05) in the first 72 h following extubation. Respiratory rate and incidence of reintubation as well as needing noninvasive ventilation were also decreased in HFNCG (P < 0.05), whereas the incidence of pneumonia and atelectasis were similar (P > 0.05). Adverse effects as throat and nasal pain occurred more frequently in COG. Conclusions. HFNC application improves oxygenation and reduces the risk of reintubation following thoracoscopic lobectomy but cannot decrease the incidence of PPC.

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Section: Discussionmentioning

confidence: 99%

Effect of High-Flow Nasal Cannula versus Conventional Oxygen Therapy for Patients with Thoracoscopic Lobectomy after Extubation

Qian

Liu³

et al. 2017

Canadian Respiratory Journal

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“…Prospective RCTs in both the ICU and the postoperative period have found that HFNC is non-inferior to NIPPV in terms of preventing respiratory failure but is better tolerated in terms of patients’ comfort 120121. One of the largest trials to examine the potential role for HFNC in preventing postoperative respiratory failure is OPERA, in which 220 post-abdominal surgery patients were randomized to receive either HFNC or standard oxygen therapy 122. No significant differences were found between groups in the absolute reduction in risk of hypoxemia or in the incidence of PPCs.…”

Section: Additional Considerationsmentioning

confidence: 99%

Perioperative lung protective ventilation

O’Gara

Talmor

2018

BMJ

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Perioperative lung injury is a major source of postoperative morbidity, excess healthcare use, and avoidable mortality. Many potential inciting factors can lead to this condition, including intraoperative ventilator induced lung injury. Questions exist as to whether protective ventilation strategies used in the intensive care unit for patients with acute respiratory distress syndrome are equally beneficial for surgical patients, most of whom do not present with any pre-existing lung pathology. Studied both individually and in combination as a package of intraoperative lung protective ventilation, the use of low tidal volumes, moderate positive end expiratory pressure, and recruitment maneuvers have been shown to improve oxygenation and pulmonary physiology and to reduce postoperative pulmonary complications in at risk patient groups. Further work is needed to define the potential contributions of alternative ventilator strategies, limiting excessive intraoperative oxygen supplementation, use of non-invasive techniques in the postoperative period, and personalized mechanical ventilation. Although the weight of evidence strongly suggests a role for lung protective ventilation in moderate risk patient groups, definitive evidence of its benefit for the general surgical population does not exist. However, given the shift in understanding of what is needed for adequate oxygenation and ventilation under anesthesia, the largely historical arguments against the use of intraoperative lung protective ventilation may soon be outdated, on the basis of its expanding track record of safety and efficacy in multiple settings.

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“…In another study, the preventive application of NHF directly after extubation was compared to SOT in patients undergoing major abdominal surgeries. NHF was ineffective at reducing the incidence of hypoxaemia as well as other postoperative outcomes such as pulmonary complications and length of hospital stay [54]. The small sample size, along with the lower than expected rate of hypoxaemia after surgery might have influenced the results, and thus more studies are needed to clarify the role of NHF after abdominal surgery.…”

Section: No Benefitmentioning

confidence: 98%

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

2017

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Nasal high flow is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. The administration of a high flow of heated and humidified gas mixture promotes higher and more stable inspiratory oxygen fraction values, decreases anatomical dead space and generates a positive airway pressure that can reduce the work of breathing and enhance patient comfort and tolerance. Nasal high flow has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxaemic respiratory failure, with the majority of studies showing positive results. Recently, its clinical indications have been expanded to post-extubated patients in intensive care or following surgery, for pre-and peri-oxygenation during intubation, during bronchoscopy, in immunocompromised patients and in patients with "do not intubate" status. In the present review, we differentiate studies that suggest an advantage (benefit) from other studies that do not suggest an advantage (no benefit) compared to conventional oxygen devices or noninvasive ventilation, and propose an algorithm in cases of nasal high flow application in patients with acute hypoxaemic respiratory failure of almost any cause.

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Effect of early postextubation high-flow nasal cannula vs conventional oxygen therapy on hypoxaemia in patients after major abdominal surgery: a French multicentre randomised controlled trial (OPERA)

Abstract: Among patients undergoing major abdominal surgery, early preventive application of high-flow nasal cannula oxygen therapy after extubation did not result in improved pulmonary outcomes compared with standard oxygen therapy.

Cited by 165 publications

References 29 publications

Effect of High-Flow Nasal Cannula versus Conventional Oxygen Therapy for Patients with Thoracoscopic Lobectomy after Extubation

Effect of High-Flow Nasal Cannula versus Conventional Oxygen Therapy for Patients with Thoracoscopic Lobectomy after Extubation

Perioperative lung protective ventilation

Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device

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