TY - JOUR
T1 - Heated humidified high-flow nasal cannula oxygen after thoracic surgery — A randomized prospective clinical pilot trial
AU - Brainard, Jason
AU - Scott, Benjamin K.
AU - Sullivan, Breandan L.
AU - Fernandez-Bustamante, Ana
AU - Piccoli, Jerome R.
AU - Gebbink, Morris G.
AU - Bartels, Karsten
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Background Thoracic surgery patients are at high-risk for adverse pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen (HHFNC O2) may decrease such events. We hypothesized that patients randomized to prophylactic HHFNC O2 would develop fewer pulmonary complications compared to conventional O2 therapy. Methods and patients Fifty-one patients were randomized to HHFNC O2 vs. conventional O2. The primary outcome was a composite of postoperative pulmonary complications. Secondary outcomes included oxygenation and length of stay. Continuous variables were compared with t-test or Mann-Whitney-U test, categorical variables with Fisher's Exact test. Results There were no differences in postoperative pulmonary complications based on intention to treat [two in HHFNC O2 (n = 25), two in control (n = 26), p = 0.680], and after exclusion of patients who discontinued HHFNC O2 early [one in HHFNC O2 (n = 18), two in control (n = 26), p = 0.638]. Discomfort from HHFNC O2 occurred in 11/25 (44%); 7/25 (28%) discontinued treatment. Conclusions Pulmonary complications were rare after thoracic surgery. Although HHFNC O2 did not convey significant benefits, these results need to be interpreted with caution, as our study was likely underpowered to detect a reduction in pulmonary complications. High rates of patient-reported discomfort with HHFNC O2 need to be considered in clinical practice and future trials.
AB - Background Thoracic surgery patients are at high-risk for adverse pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen (HHFNC O2) may decrease such events. We hypothesized that patients randomized to prophylactic HHFNC O2 would develop fewer pulmonary complications compared to conventional O2 therapy. Methods and patients Fifty-one patients were randomized to HHFNC O2 vs. conventional O2. The primary outcome was a composite of postoperative pulmonary complications. Secondary outcomes included oxygenation and length of stay. Continuous variables were compared with t-test or Mann-Whitney-U test, categorical variables with Fisher's Exact test. Results There were no differences in postoperative pulmonary complications based on intention to treat [two in HHFNC O2 (n = 25), two in control (n = 26), p = 0.680], and after exclusion of patients who discontinued HHFNC O2 early [one in HHFNC O2 (n = 18), two in control (n = 26), p = 0.638]. Discomfort from HHFNC O2 occurred in 11/25 (44%); 7/25 (28%) discontinued treatment. Conclusions Pulmonary complications were rare after thoracic surgery. Although HHFNC O2 did not convey significant benefits, these results need to be interpreted with caution, as our study was likely underpowered to detect a reduction in pulmonary complications. High rates of patient-reported discomfort with HHFNC O2 need to be considered in clinical practice and future trials.
KW - Heated high flow oxygen
KW - Pulmonary complications
KW - Pulmonary dysfunction
KW - Thoracic surgery
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U2 - 10.1016/j.jcrc.2017.04.023
DO - 10.1016/j.jcrc.2017.04.023
M3 - Article
C2 - 28454060
AN - SCOPUS:85020716093
SN - 0883-9441
VL - 40
SP - 225
EP - 228
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -