Heated humidified high-flow nasal cannula oxygen after thoracic surgery A randomized prospective clinical pilot trial

Background: Thoracic surgery patients are at high-risk for adverse pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen (HHFNC O-2) may decrease such events. We hypothesized that patients randomized to prophylactic HHFNC O-2 would develop fewer pulmonary complications compared to conventional O-2 therapy. Methods and patients: Fifty-one patients were randomized to HHFNC O-2 vs. conventional O-2. The primary outcome was a composite of postoperative pulmonary complications. Secondary outcomes included oxygenation and length of stay. Continuous variables were compared with t-test or Mann-Whitney-U test, categorical variables with Fisher's Exact test. Results: There were no differences in postoperative pulmonary complications based on intention to treat [two in HHFNC O-2 (n = 25), two in control (n = 26), p = 0.680], and after exclusion of patients who discontinued HHFNC O-2 early [one in HHFNC O-2 (n = 18), two in control (n = 26), p = 0.638]. Discomfort from HHFNC O-2 occurred in 11/25 (44%); 7/25 (28%) discontinued treatment. Conclusions: Pulmonary complications were rare after thoracic surgery. Although HHFNC O-2 did not convey significant benefits, these results need to be interpreted with caution, as our study was likely underpowered to detect a reduction in pulmonary complications. High rates of patient-reported discomfort with HHFNC O-2 need to be considered in clinical practice and future trials. (C) 2017 Elsevier Inc. All rights reserved.