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

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Farzaneh Enayati ◽  
Shahram Amini ◽  
Mohammad Gholizadeh Gerdrodbari ◽  
Lida Jarahi ◽  
Mojgan Ansari
Keyword(s):  
Cardiac Surgery ◽  
Respiratory Failure ◽  
Oxygen Therapy ◽  
Heart Surgery ◽  
Pulmonary Complications ◽  
High Flow ◽  
Control Group ◽  
Early Extubation ◽  
Respiratory Parameters ◽  
Length Of Icu Stay

Objectives: The aim of this study was to evaluate the effect of high-flow nasal cannula (HFNC) after early extubation on children undergoing cardiac surgery. Methods: This randomized controlled clinical trial was performed among 92 children aged 1 to 24 months undergoing cardiac surgery from March 5 to August 30, 2020, in a pediatric post-cardiac surgery intensive care unit (ICU). The patients were randomized to receive either HFNC or conventional oxygen therapy after extubation. Arterial blood samples were collected after anesthesia induction, after the end of the surgery, at the time of entering the ICU while they were intubated, 6 hours after entering the ICU, before removing the endotracheal tube, immediately after extubation, as well as 1, 6, 12, 24, and 36 hours after extubation. The patients were compared regarding PaCO2, PaO2/FiO2 ratios, respiratory failure, need for reintubation, development of atelectasis, pneumothorax, pleural effusion, and length of ICU stay. Results: The patients were similar regarding demographic characteristics, the duration of surgery, and mechanical ventilation (P > 0.05). On the first and second days after the surgery, the mean modified radiologic atelectasis score (m-RAS) was lower in the HFNC group compared to the conventional oxygen therapy group (P < 0.05). The frequency of respiratory failure did not differ in the groups before and after the surgery (P > 0.05). PaCO2 was lower in the HFNC group than in the control group after extubation (P < 0.001). PaO2/FIO2 ratio was significantly higher in the HFNC group one hour after extubation and afterward in comparison to the control group (P < 0.001). The need for re-intubation (P < 0.013) and the length of ICU stay (P < 0.001) were significantly lower in the HFNC group compared to the control group. Conclusions: It was found that HFNC could improve the respiratory parameters and reduce postoperative pulmonary complications in infants following a congenital heart surgery.

scholarly journals High-flow nasal oxygen reduces endotracheal intubation: a randomized clinical trial

2020 ◽  
Vol 14 ◽  
pp. 175346662095645
Author(s):  
Ricardo Andino ◽  
Gema Vega ◽  
Sandra Karina Pacheco ◽  
Nuria Arevalillo ◽  
Ana Leal ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Respiratory Failure ◽  
Endotracheal Intubation ◽  
Oxygen Therapy ◽  
High Flow ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Number Needed To Treat ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

Background: The benefits of high-flow nasal cannula (HFNC) as primary intervention in patients with acute hypoxemic respiratory failure (AHRF) are still a matter in debate. Our objective was to compare HFNC therapy versus conventional oxygen therapy (COT) in the prevention of endotracheal intubation in this group of patients. Methods: An open-label, controlled and single-centre clinical trial was conducted in patients with severe AHRF, defined by a PaO2/FIO2 ratio ⩽200, to compare HFNC with a control group (CG) treated by COT delivered through a face mask, with the need to perform intubation as the primary outcome. The secondary outcomes included tolerance of the HFNC device and to look for the predictive factors for intubation in these patients. Results: A total of 46 patients were included (22 in the COT group and 24 in the HFNC group) 48% of whom needed intubation: 63% in the COT group and 33% in the HFNC group, with significant differences both in intention to treat [χ2 = 4.2; p = 0.04, relative risk (RR) = 0.5; confidence interval (CI) 95%: 0.3–1.0] and also in treatment analysis (χ2 = 4.7; p = 0.03; RR = 0.5; IC 95%: 0.3–0.9) We obtained a number needed to treat (NNT) = 3 patients treated to avoid an intubation. Intubation occurred significantly later in the HFNC group. Estimated PaO2/FIO2, respiratory rate and dyspnea were significantly better in the HFNC group. Patients treated with HFNC who required intubation presented significant worsening after the first 8 h, as compared with non-intubated HFNC group patients. Mortality was 22% with no differences. The HFNC group patients were hospitalized for almost half of the time in the intensive care unit (ICU) and in the ward, with significantly less hospital length of stay. A total of 14 patients in the HFNC group (58%) complained of excessive heat and 17% of noise; 3 patients did not tolerate HFNC. Conclusion: Patients with severe acute hypoxemic respiratory failure who tolerate HFNC present a significantly lower need for endotracheal intubation compared with conventional oxygen therapy. Clinical Trial Register EUDRA CT number: 2012-001671-36 The reviews of this paper are available via the supplemental material section.

scholarly journals Effect of post-extubation high-flow nasal cannula on reintubation in elderly patients: a retrospective propensity score-matched cohort study

2020 ◽  
Vol 14 ◽  
pp. 175346662096849
Author(s):  
Ryoung-Eun Ko ◽  
Chul Park ◽  
Jimyoung Nam ◽  
Myeong Gyun Ko ◽  
Soo Jin Na ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Propensity Score ◽  
Elderly Patients ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
Control Group ◽  
High Flow Nasal Cannula ◽  
Mechanically Ventilated ◽  
Clinical Benefits

Background: Studies of mechanically ventilated patients with a low risk of reintubation have suggested that the use of high-flow nasal cannula (HFNC) oxygen therapy reduces the risk of reintubation compared with conventional oxygen therapy (COT). However, the effect of HFNC following extubation in elderly patients with a high risk of reintubation remains unclear. Methods: All consecutive medical intensive care unit (ICU) patients aged >65 years who were mechanically ventilated for >24 h were prospectively registered between July 2017 and June 2018. Control was obtained from a historical database of patients attending the same ICU from January 2012 to December 2013. A total of 152 patients who underwent HFNC after planned extubation according to institutional protocols (HFNC group) were compared with a propensity-matched historical control group who underwent COT ( n = 175, COT group). The primary outcome was the proportion of reintubated patients within 48 h after planned extubation. Results: One hundred patients from the HFNC group and 129 patients from the COT group were matched by a propensity score that reflected the probability of receiving HFNC, and all variables were well matched. Post-extubation respiratory failure (41.0% versus 33.3%, p = 0.291) and reintubation rate within 48 h (16.0% versus 11.6%, p = 0.436) did not differ between the HFNC and COT groups. However, decreased levels of consciousness as a sign of post-extubation respiratory failure (27.0% versus 11.7%, p = 0.007) were significantly increased in the HFNC group compared with the COT group. Conclusion: Among elderly patients who underwent planned extubation, HFNC was not associated with a decrease in the risk of reintubation. Further prospective study evaluating the clinical benefits of post-extubation HFNC in elderly patients is needed. The reviews of this paper are available via the supplemental material section.

scholarly journals High Flow Oxygen Therapy in Patients with Burn Injury

2021 ◽  
Vol 18 (3) ◽  
pp. 46-52
Author(s):  
А. А. Ponomarev ◽  
V. V. Kazennov ◽  
А. N. Kudryavtsev ◽  
А. V. Korneev ◽  
А. А. Аlekseev
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
Burn Injury ◽  
Main Group ◽  
High Flow ◽  
Infusion Therapy ◽  
Control Group ◽  
Interstitial Pulmonary Edema ◽  
High Flow Oxygen ◽  
Respiratory Comfort

Some patients with severe burn injury have a high risk of developing acute respiratory failure, the cause of which may be interstitial pulmonary edema caused by inadequate infusion therapy.The objective: to evaluate the effectiveness of high-flow oxygen therapy (HFOT) in acute parenchymatous respiratory failure in burn patients.Subjects and methods. The prospective analysis included 74 patients with ARF in the stage of burn toxemia, without inhalation trauma, with PaO2/FiO2 below 300. In Main Group (37 patients), HFOT was used, while in Control Group patients received oxygenation through nasal cannula with the rate up to 15 l/min. Parameters of respiratory rate, PaO2/FiO2, PaCO2, MAP, heart rate, the number of intubations, respiratory comfort were recorded within 48 hours.Results. Main Group had higher values of oxygenation index in 48 hours of the trial (342 vs. 305.5, p = 0.02), faster normalization of blood gas composition compared to Control Group. HFOT was associated with greater respiratory comfort (8.4 vs. 5.3 VAS scores, p = 0.03), lower need in mechanical ventilation (4 vs. 11, p = 0.04).Conclusion: HFOT is an effective method for the treatment of respiratory failure in inpatients with burns. The need for intubation decreases, it is more comfortable to be tolerated than standard methods of oxygen therapy.

Bedside Ultrasound Assessment of Lung Reaeration in Patients With Blunt Thoracic Injury Receiving High-Flow Nasal Cannula Oxygen Therapy: A Retrospective Study

2018 ◽  
Vol 35 (10) ◽  
pp. 1095-1103
Author(s):  
Xiao Lu ◽  
ChunShuang Wu ◽  
YuZhi Gao ◽  
Mao Zhang
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
Lung Ultrasound ◽  
High Flow ◽  
Nasal Cannula ◽  
Trauma Patients ◽  
High Flow Nasal Cannula ◽  
Lung Aeration ◽  
Ultrasound Assessment ◽  
Length Of Icu Stay

Background: High-flow nasal cannula (HFNC) oxygen therapy has been shown to reduce the need for mechanical ventilation and decrease the duration of hospital and intensive care unit (ICU) stays for patients with a severely compromised respiratory system. This study aims to observe the evolution of lung aeration via lung ultrasound score (LUS) in a chest-injured population who had been treated with HFNC oxygen therapy, and to assess the benefit of the HFNC oxygen therapy in trauma patients. Methods: A retrospective study examined trauma patients with moderate to severe thoracic injuries who were admitted to the ICU at a tertiary hospital between October 2015 and March 2017. The decision to initiate HFNC oxygen therapy was made at the discretion of the trauma surgeon and respiratory therapist when supplemental oxygen delivery was required. All of the patients were assessed by transthoracic lung ultrasound every day after being admitted into the ICU. We retrospectively analyzed 3 time points for this study: the initial emergency intensive care units presentation within 12 hours (T1), 24 to 48 hours after the treatment (T2), and 72 to 96 hours after the treatment (T3). Transthoracic lung ultrasound was performed by an experienced investigator with level 3 certification using a Mindray M9 echograph and a 2- to 4-MHz round-tipped probe. Primary outcomes were the need for intubation after HFNC oxygen therapy for respiratory failure during the treatment within 72 hours, the length of ICU stay, and mortality of 28 days. Results: During the study period, 50 patients with blunt chest trauma were admitted to the study; 18 patients received HFNC therapy and 32 received conventional oxygen therapy (COT); there was no significant difference in the baseline clinical characteristics between the 2 groups. The length of ICU stay and intubation rate for respiratory failure within 72 hours were significantly different between the 2 groups ( P < .05), but there was no difference in the 28-day mortality. The LUS of the COT group was not significantly different from T1 to T2 or from T2 to T3 ( P > .05). However, the LUS decreased significantly—by 25% from T1 to T2 ( P < .05) and by 31% from T1 to T3 ( P < .05) in the HFNC therapy group. The LUS of the patients intubated for respiratory failure within 72 hours, in the COT group increased from T1 (17 ± 3) to T3 (21 ± 3), and the LUS (21 ± 3) was much higher than the patients who were not intubated (11 ± 3) at T3; the LUS of the HFNC group was all above 15, which was not significantly different from T1 to T2 or from T2 to T3 ( P > .05). Conclusions: High-flow nasal cannula oxygen therapy may be considered as an initial respiratory therapy for trauma patients with blunt chest injury. High-flow nasal cannula therapy could improve lung aeration as noted by the transthoracic lung ultrasound assessment, and LUS may help the attending physicians identify the usefulness of HFNC therapy and decide whether to continue the use of HFNC therapy or intubate the patient.

The Effect of High-Flow Nasal Oxygen Therapy on Postoperative Pulmonary Complications and Hospital Length of Stay in Postoperative Patients: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 35 (10) ◽  
pp. 1129-1140 ◽  
Author(s):  
Zhonghua Lu ◽  
Wei Chang ◽  
Shanshan Meng ◽  
Ming Xue ◽  
Jianfeng Xie ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Oxygen Therapy ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
High Flow ◽  
Hospital Length Of Stay ◽  
Cochrane Library ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
High Flow Oxygen

Objective: To evaluate the effect of high-flow nasal cannula oxygen (HFNO) therapy on hospital length of stay (LOS) and postoperative pulmonary complications (PPCs) in adult postoperative patients. Data Sources: PubMed, Embase, the Cochrane Library, Web of Science of Studies, China National Knowledge Index, and Wan Fang databases were searched until July 2018. Study Selection: Randomized controlled trials (RCTs) comparing HFNO with conventional oxygen therapy or noninvasive mechanical ventilation in adult postoperative patients were included. The primary outcomes were hospital LOS and PPCs; short-term mortality (defined as intensive care unit, hospital, or 28-day mortality) and intubation rate were the secondary outcomes. Data Extraction: Demographic variables, high-flow oxygen therapy application, effects, and side effects were retrieved. Data were analyzed by the methods recommended by the Cochrane Collaboration. The strength of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation. Random errors were evaluated with trial sequential analysis. Data Synthesis: Fourteen studies (2568 patients) met the inclusion criteria and were included. Compared to the control group, the pooled effect showed that HFNO was significantly associated with a shorter hospital stay (mean difference: −0.81; 95% confidence interval [CI]: −1.34 to −0.29, P = .002), but not mortality (risk ratio [RR]: 1.0, 95% CI: 0.63 to 1.59, P = 1.0). Weak evidence of a reduction in reintubation rate (RR: 0.76, 95% CI: 0.57-1.01, P = .06) and PPC rate (RR: 0.89, 95% CI: 0.75-1.06, P = .18) with HFNO versus control group was recorded. Conclusions: The available RCTs suggest that, among the adult postoperative patients, HFNO therapy compared to the control group significantly reduces hospital LOS.

The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

2012 ◽  
Vol 15 (2) ◽  
pp. 84 ◽  
Author(s):  
Canturk Cakalagaoglu ◽  
Cengiz Koksal ◽  
Ayse Baysal ◽  
Gokhan Alici ◽  
Birol Ozkan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Pericardial Tamponade ◽  
Anxiety Level ◽  
Control Group ◽  
Echocardiographic Study ◽  
Number Of Patients ◽  
Hospital Stays

<p><b>Aim:</b> The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).</p><p><b>Materials and Methods:</b> We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.</p><p><b>Results:</b> The 2 groups were not significantly different with respect to demographic and operative data (<i>P</i> > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (<i>P</i> < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (<i>P</i> < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (<i>P</i> = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.</p><p><b>Conclusion:</b> Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.</p>

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