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Nasal High Flow Versus Conventional Oxygen Therapy for Postoperative Cardiothoracic Surgery Patients

Fasolino, Tracy PhD, RN; Whitten, Joseph RCP; Moylan, Melanie MSc, PhD

doi: 10.1097/DCC.0000000000000389
Research DIMENSION
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Background 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.

Objectives The objective of this study was to understand whether NHF therapy would reduce the need for reintubation and improve clinical outcomes after surgery.

Method 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.

Results 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).

Discussion 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.

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.

Fisher & Paykel Healthcare supported Bon Secours Hospital with Airvo 2 devices and consumables for clinical evaluation during the study period.

M.M. was an employee of Fisher & Paykel Healthcare, New Zealand, after the clinical evaluation had been conducted.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Tracy Fasolino, PhD, RN, Palmetto Pulmonary & Critical Care Associates, 3 St. Francis Dr, Suite #300, Greenville, SC 29601 (tracy_fasolino@bshsi.org).

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