Fasolino Tracy, Whitten Joseph, Moylan Melanie
Tracy Fasolino, PhD, RN, is an associate professor/nurse researcher at Clemson University/Bon Secours St. Francis. She is dedicated to improving symptom management for hospitalized patients by working with intradisciplinary teams. Joseph Whitten, RCP, is the Director of Respiratory Care Services at Bon Secours St. Francis Health. He is committed to finding effective solutions for achieving quality and value in health care. Melanie Moylan, MSc, PhD, is a research fellow and clinical scientist of biostatistics and epidemiology at Auckland University of Technology. She is interested in evaluating innovations and developing clinical pathways to improve health care.
Dimens Crit Care Nurs. 2019 Nov/Dec;38(6):310-316. doi: 10.1097/DCC.0000000000000389.
Reintubation and complications in postoperative cardiothoracic patients remain high despite medical advancements. A 2-year retrospective, observational study was conducted in postextubated cardiothoracic patients to assess the effectiveness of the current standard-conventional oxygen therapy (COT) compared with a nasal high flow (NHF) therapy.
The objective of this study was to understand whether NHF therapy would reduce the need for reintubation and improve clinical outcomes after surgery.
All consecutive postoperative patients who had same-day elective cardiothoracic surgery in a tertiary hospital were included. The 2013 data were from patients' charts who received COT, and the 2014 data were from patients' charts after the implementation of NHF therapy post extubation as a standard of care.
A total of 400 patient charts were analyzed: 221 and 179 patients in the COT and NHF, respectively. No significant difference was seen in the frequency of reintubation (P = .48). Despite both cohorts having the same length of stay (P = .10), patients treated with NHF required less time on supplemental oxygen (P = .001). Day 1 postoperative chest x-ray results did not show any significant differences between groups, whereas day 2 x-rays showed worsening results in the COT cohort (P < .001). Furthermore, the incidence of ventilator-associated pneumonia (VAP) post extubation was significantly higher in the COT cohort, with zero VAP episodes reported in the NHF cohort (P = .02).
Although this study was not able to demonstrate the reduction in reintubation between groups, the use of NHF compared with COT seems to reduce the time spent on oxygen therapy and decrease the rate of VAP. Further evidence including randomized controlled trials is required to determine the impact of NHF on reintubation and complications in postoperative cardiothoracic surgery.
尽管医学不断进步，但心胸外科术后患者的再次插管及并发症发生率仍然很高。对拔管后的心胸外科患者进行了一项为期2年的回顾性观察研究，以评估当前标准的传统氧疗（COT）与经鼻高流量（NHF）氧疗的有效性。
本研究的目的是了解NHF氧疗是否能减少再次插管的需求并改善术后临床结局。
纳入一家三级医院同日进行择期心胸外科手术的所有连续术后患者。2013年的数据来自接受COT治疗患者的病历，2014年的数据来自拔管后实施NHF氧疗作为标准治疗的患者病历。
共分析了400份患者病历：COT组和NHF组分别为221例和179例。再次插管频率无显著差异（P = 0.48）。尽管两组的住院时间相同（P = 0.10），但接受NHF治疗的患者吸氧时间较短（P = 0.001）。术后第1天的胸部X光检查结果在两组之间未显示任何显著差异，而第2天的X光检查显示COT组结果恶化（P < 0.001）。此外，COT组拔管后呼吸机相关性肺炎（VAP）的发生率显著更高，NHF组报告的VAP发作次数为零（P = 0.02）。
尽管本研究未能证明两组之间再次插管率的降低，但与COT相比，NHF的使用似乎减少了氧疗时间并降低了VAP发生率。需要包括随机对照试验在内的进一步证据来确定NHF对心胸外科术后再次插管和并发症的影响。
