Impact of early high flow nasal oxygen on diaphragmatic function and pulmonary complications after thoracic surgery: A randomized clinical trial.
作者信息
Fogagnolo Alberto, Grasso Salvatore, Dres Martin, Azzolina Danila, Dalla Corte Francesca, Dolci Giampiero, Tamburini NIcola, De Paoli Giovanni, Murgolo Francesco, Pedarzani Emma, Andalò Arianna, Volta Carlo Alberto, Savino Spadaro
机构信息
Emergency Department, Section of Anaesthesia and Intensive Care, Azienda Ospedaliera-Universitaria Sant' Anna, Ferrara, Italy.
Department of Precision-Regenerative Medicine and Jonic Area (DiMePRe-J), Section of Anesthesiology and Intensive Care Medicine, University of Bari "Aldo Moro", Bari, Italy.
出版信息
J Clin Anesth. 2025 Sep;106:111945. doi: 10.1016/j.jclinane.2025.111945. Epub 2025 Jul 23.
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 mixed-model analysis confirmed that HFNC reduced the risk of PPCs in patients with diaphragmatic dysfunction (OR 0.16, 95 % CI 0.02-0.83).
CONCLUSIONS
Early HFNC support does not decrease the rate of postoperative diaphragmatic dysfunction rate or respiratory complications. In patients who develop postoperative diaphragmatic dysfunction, HFNC may play a role in mitigating the risk of PPCs.
CLINICAL TRIAL REGISTRATION
NCT05532033.
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