Effect of High-Flow Nasal Oxygen on Respiratory Parameters and Pulmonary Complications After Early Extubation Following Pediatric Heart Surgery

Enayati, Farzaneh; Amini, Shahram; Gerdrodbari, Mohammad Gholizadeh; Jarahi, Lida; Ansari, Mojgan

doi:10.5812/compreped.116104

Cited by 3 publications

(9 citation statements)

References 28 publications

(40 reference statements)

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“…First, we conducted a sensitivity analysis to compare tracheal extubation failure rates between HFNC and COT groups. By excluding the study by Enayati et al, we found no substantial difference between HFNC and COT, and the heterogeneity was resolved (RR = 1.14, 95% CI: 0.52 to 2.49, p = .75, I 2 = 0%) 27 . Next, concerning postoperative LOS in HFNC versus NIV, despite performing sensitivity analyses, the heterogeneity remained unresolved.…”

Section: Resultsmentioning

confidence: 69%

“…Among these, 12 met the inclusion criteria. Of those, seven studies compared HFNC to NIV, 1,[20][21][22][23][24][25] four studies compared HFNC to COT, [26][27][28][29] and one was an observational single-arm study. 30 The studies comparing HFNC to NIV consisted of five observational cohort studies (one prospective and four retrospective), 1,20,22,24,25 one RCT, 21 and one case-controlled observational study.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…No difference was noted in the primary outcome of the need for tracheal reintubation between these two groups (RR = 0.67, 95% CI: 0.24-1.90, p = .46, I 2 = 63%, p = .03; Figure 1B). [26][27][28][29]…”

Section: Primary Outcome-need For Tracheal Reintubationmentioning

confidence: 99%

“…By excluding the study by Enayati et al, we found no substantial difference between HFNC and COT, and the heterogeneity was resolved (RR = 1.14, 95% CI: 0.52 to 2.49, p = .75, I 2 = 0%). 27…”

Section: Sensitivity Analysismentioning

confidence: 99%

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Use of high‐flow nasal cannula versus other noninvasive ventilation techniques or conventional oxygen therapy for respiratory support following pediatric cardiac surgery: A systematic review and meta‐analysis

Elmitwalli,

Abdelhady,

Kalsotra

et al. 2024

Pediatric Anesthesia

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IntroductionNoninvasive respiratory support may be provided to decrease the risk of postextubation failure following surgery. Despite these efforts, approximately 3%–27% of infants and children still experience respiratory failure after tracheal extubation following cardiac surgery. This systematic review evaluates studies comparing the efficacy of high‐flow nasal cannula to conventional oxygen therapy such as nasal cannula and other noninvasive ventilation techniques in preventing postextubation failure in this patient population.MethodsA systematic and comprehensive search was conducted in major databases including MEDLINE, EMBASE, Web of Science, and Central. The search encompassed articles focusing on the prophylactic use of high‐flow nasal cannula following tracheal extubation in pediatric patients undergoing cardiac surgery for congenital heart disease. The inclusion criteria for this review consisted of randomized clinical trials as well as observational, cohort, and case–control studies.ResultsA total of 1295 studies were screened and 12 studies met the inclusion criteria. These 12 studies included a total of 1565 children, classified into three groups: seven studies compared high‐flow nasal cannula to noninvasive ventilation techniques, four studies compared high‐flow nasal cannula to conventional oxygen therapy, and one observational single‐arm study explored the use of high‐flow nasal cannula with no control group. There was no significant difference in the incidence of tracheal reintubation between high‐flow nasal cannula and conventional oxygen therapy (risk ratio [RR] = 0.67, 95% confidence interval [CI]: 0.24–1.90, p = .46). However, there was a lower incidence of tracheal reintubation in patients who were extubated to high‐flow nasal cannula versus those extubated to noninvasive ventilation techniques (RR = 0.45, 95% CI: 0.32–0.63, p < .01). The high‐flow nasal cannula group also demonstrated a lower mortality rate compared to the noninvasive ventilation techniques group (RR = 0.31, 95% CI: 0.16–0.61, p < .01) as well as a shorter postoperative length of stay (mean difference = −8.76 days, 95% CI: −13.08 to −4.45, p < .01) and shorter intensive care length of stay (mean difference = −4.63 days, 95% CI: −9.16 to −0.11, p = .04).ConclusionHigh‐flow nasal cannula is more effective in reducing the rate of postextubation failure compared to other forms of noninvasive ventilation techniques following surgery for congenital heart disease in pediatric‐aged patients. high‐flow nasal cannula is also associated with lower mortality rates and shorter length of stay. However, when comparing high‐flow nasal cannula to conventional oxygen therapy, the findings were inconclusive primarily due to a limited number of scientific studies available on this specific comparison. Future study is needed to further define the benefit of high‐flow nasal cannula compared to conventional oxygen therapy and various types of noninvasive ventilation techniques.

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Section: Resultsmentioning

confidence: 69%

Section: Literature Search Resultsmentioning

confidence: 99%

Section: Primary Outcome-need For Tracheal Reintubationmentioning

confidence: 99%

Section: Sensitivity Analysismentioning

confidence: 99%

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Use of high‐flow nasal cannula versus other noninvasive ventilation techniques or conventional oxygen therapy for respiratory support following pediatric cardiac surgery: A systematic review and meta‐analysis

Elmitwalli,

Abdelhady,

Kalsotra

et al. 2024

Pediatric Anesthesia

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“…Initial search retrieved 167 abstracts, of which 10 full texts were further assessed and six studies included. 12,13,[18][19][20][21] (Figure 1).…”

Section: Search Resultsmentioning

confidence: 99%

Noninvasive respiratory support preventing reintubation after pediatric cardiac surgery—A systematic review

Kuitunen,

Uimonen

2023

Pediatric Anesthesia

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ObjectiveTo analyze the optimal postextubation respiratory support in pediatric cardiac surgery patients.DesignSystematic review of randomized controlled trials.SettingPediatric or neonatal intensive care units.ParticipantsAll aged children (<16 years) having cardiac surgery and postoperative invasive ventilation.InterventionNoninvasive respiratory support, including high flow nasal cannula (HFNC), conventional oxygen therapy (COT), noninvasive positive pressure ventilation (NIPPV), continuous positive pressure (CPAP), and noninvasive high‐frequency oscillatory ventilation (NHFOV).Measurement and Main ResultsStudies were not pooled for statistical synthesis due to the limited number and quality of the included studies. Risk ratios with 95% confidence intervals were calculated for individual studies. A total of 167 studies were screened and six were included. The risk of bias was low in one, high in one, and had some concerns in four of the studies. Extubation failure (defined as reintubation) was the main outcome of interest. Risk ratio for reintubation was 0.10 (CI 0.02–0.40) and 1.07 (CI 0.16–7.26) in HFNC versus COT, 0.49 (CI 0.05–5.28) in HFNC versus NIPPV, 0.40 (CI 0.08–1.94) in HFNOV versus CPAP, 0.75 (CI 0.26–2.18) in HFNOV versus NIPPV, and 1.37 (CI 0.33–5.73) in CPAP versus NIPPV. Treatment durations did not differ between the groups.ConclusionWe did not find clear evidence of a difference in reintubation rates and other clinical outcomes between different noninvasive ventilation strategies. Evidence certainty was assessed to be very low due to the risk of bias, the small number of included studies, and high imprecision. Future quality studies are needed to determine the optimal postextubation support in pediatric cardiac surgery patients.

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High-flow nasal cannula use in pediatric patients for other indications than acute bronchiolitis—a scoping review of randomized controlled trials

Kuitunen,

Salmi,

Wärnhjelm

et al. 2023

Eur J Pediatr

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The objective of the study is to summarize current literature on high-flow nasal cannula (HFNC) use for different indications in pediatric patient excluding acute bronchiolitis and neonatal care. The study design is a systematic scoping review. Pubmed, Scopus, and Web of Science databases were searched in February, 2023. All abstracts and full texts were screened by two independent reviewers. Randomized controlled trials focusing on HFNC use in pediatric patients (age < 18 years) were included. Studies focusing on acute bronchiolitis and neonatal respiratory conditions were excluded. Study quality was assessed by Cochrane risk of bias 2.0 tool. The main outcomes are patient groups and indications, key outcomes, and risk of bias. After screening 1276 abstracts, we included 22 full reports. Risk of bias was low in 11 and high in 5 studies. We identified three patient groups where HFNC has been studied: first, children requiring primary respiratory support for acute respiratory failure; second, perioperative use for either intraprocedural oxygenation or postoperative respiratory support; and third, post-extubation care in pediatric intensive care for other than postoperative patients. Clinical and laboratory parameters were assessed as key outcomes. None of the studies analyzed cost-effectiveness.Conclusion: This systematic scoping review provides an overview of current evidence for HFNC use in pediatric patients. Future studies should aim for better quality and include economic evaluation with cost-effectiveness analysis.Protocol registration: Protocol has been published https://osf.io/a3y46/. What is Known:• High flow nasal cannula has been effective in acute bronchiolitis and neonatal respiratory care.• The use of HFNC on other conditions is also common and increasing, but the evidence supporting this has not been previously summarized. What is New:• We found that HFNC has been studies in relatively few studies in children for other indication than bronchiolitis.• We indetified three main patient populations for which HFNC has been studied: perioperative patients, postintubation patients in intensive care units, and as primary support in acute respiratory failures. None of the studies have estimated possible cost-effectiveness of HFNC, compared to alternative strategies.

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Effect of High-Flow Nasal Oxygen on Respiratory Parameters and Pulmonary Complications After Early Extubation Following Pediatric Heart Surgery

Cited by 3 publications

References 28 publications

Use of high‐flow nasal cannula versus other noninvasive ventilation techniques or conventional oxygen therapy for respiratory support following pediatric cardiac surgery: A systematic review and meta‐analysis

Use of high‐flow nasal cannula versus other noninvasive ventilation techniques or conventional oxygen therapy for respiratory support following pediatric cardiac surgery: A systematic review and meta‐analysis

Noninvasive respiratory support preventing reintubation after pediatric cardiac surgery—A systematic review

High-flow nasal cannula use in pediatric patients for other indications than acute bronchiolitis—a scoping review of randomized controlled trials

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