Heated humidified high-flow nasal cannula oxygen after thoracic surgery - A randomized prospective clinical pilot trial.

BACKGROUND

Thoracic surgery patients are at high-risk for adverse pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen (HHFNC O) may decrease such events. We hypothesized that patients randomized to prophylactic HHFNC O would develop fewer pulmonary complications compared to conventional O therapy.

METHODS AND PATIENTS

Fifty-one patients were randomized to HHFNC O vs. conventional O. 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 O (n=25), two in control (n=26), p=0.680], and after exclusion of patients who discontinued HHFNC O early [one in HHFNC O (n=18), two in control (n=26), p=0.638]. Discomfort from HHFNC O occurred in 11/25 (44%); 7/25 (28%) discontinued treatment.

CONCLUSIONS

Pulmonary complications were rare after thoracic surgery. Although HHFNC O 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 O need to be considered in clinical practice and future trials.