Zochios
Trial question
What is the effect of prophylactic high-flow nasal oxygen use in cardiac surgical patients at high risk for postoperative respiratory complications?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
38.3% female
61.7% male
N = 100
100 patients (36 female, 58 male).
Inclusion criteria: adult patients with pre-existing respiratory disease undergoing elective cardiac surgery.
Key exclusion criteria: presence of a nasal septal defect, need for CPAP therapy pre‐operatively or unmet criteria for tracheal extubation the day after surgery.
Interventions
N=51 high-flow nasal oxygen (the FiO2 titrated to provide oximetry saturation of at least 95% (93% for those at risk of hypercapnic respiratory failure); standard starting flow rate of 30 L/min).
N=49 standard oxygen therapy (low‐flow oxygen via nasal prongs or a soft facemask titrated to provide oximetry saturations of at least 95% (93% for those at risk of hypercapnic respiratory failure)).
Primary outcome
Total length of hospital stay
7 days
9 days
9.0 days
6.8 days
4.5 days
2.3 days
0.0 days
High-flow nasal
oxygen
Standard oxygen
therapy
Significant
decrease ▼
Significant decrease in the total length of hospital stay (7 days vs. 9 days; AD -2 days, 95% CI -3.56 to -0.44).
Secondary outcomes
Significant decrease in re-admission to ICU (2% vs. 15.6%; RR 0.13, 95% CI 0.02 to 0.24).
No significant difference in mean postoperative six-minute walk test (207.3 m vs. 186.1 m; AD 21.3 m, 95% CI -44 to 86.6).
No significant difference in forced expiratory volume in one second (1.5 vs. 1.2; AD 0.3 , 95% CI -0.14 to 0.74).
Safety outcomes
No significant difference in extra-pulmonary postoperative complications.
Conclusion
In adult patients with pre-existing respiratory disease undergoing elective cardiac surgery, high-flow nasal oxygen was superior to standard oxygen therapy with respect to the total length of hospital stay.
Reference
V Zochios, T Collier, G Blaudszun et al. The effect of high-flow nasal oxygen on hospital length of stay in cardiac surgical patients at high risk for respiratory complications: a randomised controlled trial. Anaesthesia. 2018 Dec;73(12):1478-1488.
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