High-Flow Nasal Cannula Therapy Versus Intermittent Noninvasive Ventilation in Obese Subjects After Cardiothoracic Surgery

• Published in: Respiratory care Vol. 62; no. 9; p. 1193
• Main Authors: Stéphan, François, Bérard, Laurence, Rézaiguia-Delclaux, Saida, Amaru, Priscilla
• Format: Journal Article
• Language: English
• Published: United States 01.09.2017
• Subjects: Aged; Cannula; Female; Humans; Intensive Care Units; Intermittent Positive-Pressure Ventilation - instrumentation; Intermittent Positive-Pressure Ventilation - methods; Male; Middle Aged; Noninvasive Ventilation - instrumentation; Noninvasive Ventilation - methods; Obesity - surgery; Oxygen Inhalation Therapy - instrumentation; Oxygen Inhalation Therapy - methods; Postoperative Complications - etiology; Postoperative Complications - therapy; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Thoracic Surgical Procedures - adverse effects; Treatment Outcome; respiratory failure; cardiothoracic surgery; bi-level positive airway pressure; obesity; high-flow nasal oxygen; noninvasive ventilation
• ISSN: 1943-3654
• DOI: 10.4187/respcare.05473

Obese patients are considered at risk of respiratory failure after cardiothoracic surgery. High-flow nasal cannula has demonstrated its non-inferiority after cardiothoracic surgery compared to noninvasive ventilation (NIV), which is the recommended treatment in obese patients. We hypothesized that NIV was superior to high-flow nasal cannula for preventing or resolving acute respiratory failure after cardiothoracic surgery in this population. We performed a post hoc analysis of a randomized, controlled trial. Obese subjects were randomly assigned to receive NIV for at least 4 h/d (inspiratory pressure, 8 cm H O; expiratory pressure, 4 cm H O; F , 0.5) or high-flow nasal cannula delivered continuously (flow, 50 L/min, F 0.5). Treatment failure (defined as re-intubation, switch to the other treatment, or premature discontinuation) occurred in 21 of 136 (15.4%, 95% CI 9.8-22.6%) subjects with NIV compared to 18 of 135 (13.3%, 95% CI 8.1-20.3%) subjects with high-flow nasal cannula ( = .62). No significant differences were found for dyspnea and comfort scores. Skin breakdown was significantly more common with NIV after 24 h (9.2%, 95% CI 5.0-16.0 vs 1.6%, 95% CI 1.0-6.0; = .01). No significant differences were found for ICU mortality (5.9% for subjects with NIV vs 2.2% for subjects with high-flow nasal cannula, = .22) or for any of the other secondary outcomes. Among obese cardiothoracic surgery subjects with or without respiratory failure, the use of continuous high-flow nasal cannula compared to intermittent NIV (8/4 cm H O) did not result in a worse rate of treatment failure. Because high-flow nasal cannula presents some advantages, it may be used instead of NIV in obese patients after cardiothoracic surgery.