Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.
Br J Anaesth. 2013 Dec;111(6):925-31. doi: 10.1093/bja/aet262. Epub 2013 Aug 6.
Respiratory complications after cardiac surgery increase morbidity, mortality, and length of stay. Studies suggest that routine delivery of positive airway pressure after extubation may be beneficial. We sought to determine whether the routine administration of nasal high-flow oxygen therapy (NHF) improves pulmonary function after cardiac surgery.
A pragmatic randomized controlled trial; participants received either NHF (45 litre min(-1)) or usual care from extubation to Day 2 after surgery. The primary outcome was number of patients with / ratio ≥445 on Day 3 after surgery. The secondary outcomes included atelectasis score on chest X-ray; spirometry; intensive care and hospital length of stay; mortality on Day 28; oxygenation indices; escalation of respiratory support; and patient comfort.
We randomized 340 patients over 14 months. The number of patients with a / ratio of ≥445 on Day 3 was 78 (46.4%) in the NHF group vs 72 (42.4%) standard care [odds ratio (OR) 1.18, 95% confidence interval (CI) 0.77-1.81, P=0.45]. was reduced at both 4 h post-extubation and at 9 a.m. on Day 1 in the NHF group (5.3 vs 5.4 kPa, P=0.03 and 5.1 vs 5.3 kPa, P=0.03, respectively). Escalation in respiratory support at any time in the study occurred in 47 patients (27.8%) allocated to NHF compared with 77 (45%) standard care (OR 0.47, 95% CI 0.29-0.7, P=0.001).
Routine use of NHF did not increase / ratio on Day 3 but did reduce the requirement for escalation of respiratory support.
Australia New Zealand Clinical Trials Registry www.anzctr.org.au (ACTRN12610000973011).
心脏手术后的呼吸并发症会增加发病率、死亡率和住院时间。研究表明，常规给予拔管后正压通气可能有益。我们旨在确定常规给予鼻高流量氧疗（NHF）是否能改善心脏手术后的肺功能。
一项实用的随机对照试验；参与者在手术后拔管至第 2 天接受 NHF（45 升/分钟）或常规护理。主要结局是术后第 3 天有/比≥445 的患者人数。次要结局包括胸部 X 射线的肺不张评分；肺活量测定；重症监护和住院时间；第 28 天的死亡率；氧合指数；呼吸支持的升级；和患者舒适度。
我们在 14 个月内随机分配了 340 名患者。NHF 组有 78 名（46.4%）患者在第 3 天的/比≥445，而标准护理组有 72 名（42.4%）[比值比（OR）1.18，95%置信区间（CI）0.77-1.81，P=0.45]。在 NHF 组，拔管后 4 小时和第 1 天上午 9 点的均降低（5.3 对 5.4 kPa，P=0.03 和 5.1 对 5.3 kPa，P=0.03，分别）。在研究中的任何时间，NHF 组有 47 名（27.8%）患者需要升级呼吸支持，而标准护理组有 77 名（45%）（OR 0.47，95%CI 0.29-0.7，P=0.001）。
常规使用 NHF 并没有增加第 3 天的/比，但确实减少了呼吸支持升级的需求。
澳大利亚新西兰临床试验注册 www.anzctr.org.au（ACTRN12610000973011）。
