Abstract
We aimed to investigate the risk factors and reason for initiation of high-flow nasal cannula (HFNC), its benefit on re-intubation rate, mortality, and length of stay (LOS) in the postoperative cardiac surgery patient in the ICU. Methods: In a retrospective and descriptive study, 200 patients, who underwent cardiac surgery, were randomly included, and screened for initiation of postoperative respiratory support. Demographic patient data and pre-operative patient measurements were sampled. Data concerning the P/F ratio at arrival- and post-extubation, LOS at ICU and overall mortality were sampled. A comparison of those variables was performed between patients with and without need of respiratory support. Results: HFNC was initiated in approximately 22.45% in 2018, and 25% in 2020, of the patients. Comparing both years didn’t reveal a significant rise, but we saw a quicker use of HFNC in 2020. The all-case re-intubation rate and mortality was approximately 3%. The body mass index (BMI) was the only correlation with a higher chance of initiation of HFNC. Other data like age, pre-operative renal- or left ventricle function didn’t show a correlation. Conclusion: In case of respiratory insufficiency in the postoperative cardiac surgery setting, HFNC is a worthy first line treatment option which is initiated if conventional oxygen therapy doesn’t suffice. The mortality was low, and the mean LOS was 4.38 days. If respiratory support was started with HFNC mean LOS rose to 8.35 days. The BMI seems to have a correlation with the development of respiratory failure, which confirms the latest recommendation to start preventive HFNC in the post-extubation cardiac surgery setting and which could be implemented in the daily practice.
Highlights
In the management of acute respiratory failure, heated, humidified, high-flow nasal cannula (HHHFNC or HFNC) has gained increasing popularity
If respiratory support was started with HFNC mean length of stay (LOS) rose to 8.35 days
The body mass index (BMI) seems to have a correlation with the development of respiratory failure, which confirms the latest recommendation to start preventive HFNC in the post-extubation cardiac surgery setting and which could be implemented in the daily practice
Summary
In the management of acute respiratory failure, heated, humidified, high-flow nasal cannula (HHHFNC or HFNC) has gained increasing popularity. HFNC has the ability to deliver an inspired oxygen fraction between 0.21 and 1.0, with a gas flow of 60 L/min It delivers a low level of positive pressure in the upper airways and hereby increases the airway pressure and the end-expiratory lung volume, diminishes the respiratory dead space, the work of breathing and respiratory rate [1] [2] [3] [4]. Because of these physiological benefits, it can improve oxygenation and comfort after extubation, and prevent post-extubation failure and reintubation [2] [3] [4] [5]. If post-extubation respiratory failure occurs, the ERS/ATS 2017 guidelines do not suggest use of noninvasive ventilation [3]
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