Impact of early high flow nasal oxygen on diaphragmatic function and pulmonary complications after thoracic surgery: A randomized clinical trial
Abstract
BACKGROUND
Postoperative pulmonary complications (PPCs) are common after thoracic surgery, particularly in patients that develop postoperative diaphragmatic dysfunction. High-flow nasal cannula (HFNC) oxygen therapy decreases postoperative work of breathing and provides a positive end-expiratory pressure (PEEP) effect. As a result, it may decrease the occurrence of diaphragmatic dysfunction and PPCs after thoracic surgery.
METHODS
Single-centre, open-label, randomized controlled trial. Patients undergoing video-assisted thoracoscopic lobectomy were randomized to receive conventional oxygen therapy (COT) or high flow nasal cannula oxygen therapy. In both groups, inspiratory oxygen fraction was titrated to reach a peripheral oxygen saturation of >94 %. Diaphragmatic displacement (DD) and diaphragmatic thickening fraction (TF%) were measured 2 and 24 h after surgery. Diaphragmatic dysfunction was identified by DD <10 mm. PPCs occurring within 7 days after study enrollment were recorded.
RESULTS
We analyzed 116 patients in the study. Postoperative diaphragmatic dysfunction occurred in 17/58 patients (29 %) in the HFNC group compared to 21/58 (36 %) in the COT group (p = 0.55). The rate of PPCs was similar between the two groups: 32/58 (55 %) in the HFNC group and 37/58 (64 %) in the COT group (p = 0.449). Patients who developed postoperative diaphragmatic dysfunction experienced fewer PPCs when treated with HFNC (20/37; 54 %) compared to COT (17/21; 81 %) (p = 0.037). A post hoc…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 116 participants or records.
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