Comparative evaluation of high-flow nasal cannula and conventional oxygen therapy in paediatric cardiac surgical patients: a randomized controlled trial

Giuseppina Testa, Francesca Iodice, Zaccaria Ricci, Vincenzo Vitale, Francesca De Razza, Roberta Haiberger, Claudia Iacoella, Giorgio Conti, Paola Cogo
2014 Interactive Cardiovascular and Thoracic Surgery  
OBJECTIVES: The aim of this study was to compare high-flow nasal cannula (HFNC) and conventional O 2 therapy (OT) in paediatric cardiac surgical patients; the primary objective of the study was to evaluate whether HFNC was able to improve PaCO 2 elimination in the first 48 h after extubation postoperatively. METHODS: We conducted a randomized, controlled trial in pediatric cardiac surgical patients under 18 months of age. At the beginning of the weaning of ventilation, patients were randomly
more » ... ts were randomly assigned to either of the following groups: OT or HFNC. Arterial blood samples were collected before and after extubation at the following time points: 1, 6, 12, 24 and 48 h. The primary outcome was comparison of arterial PaCO 2 postextubation; secondary outcomes were PaO 2 and PaO 2 /fractional inspired oxygen (FiO 2 ) ratio, rate of treatment failure and need of respiratory support, rate of extubation failure, rate of atelectasis, simply to complications and the length of paediatric cardiac intensive care unit stay. RESULTS: Demographic and clinical variables were comparable in the two groups. Analysis of variance for repeated measures showed that PaCO 2 was not significantly different between the HFNC and OT groups (P = 0.5), whereas PaO 2 and PaO 2 /FiO 2 were significantly improved in the HFNC group (P = 0.01 and P = 0.001). The rate of reintubation was not different in the two groups (P = 1.0), whereas the need for noninvasive respiratory support was 15% in the OT group and none in the HFNC group (P = 0.008). CONCLUSIONS: HFNC had no impact on PaCO 2 values. The use of HFNC appeared to be safe and improved PaO 2 in paediatric cardiac surgical patients.
doi:10.1093/icvts/ivu171 pmid:24912486 fatcat:jdqruwk5gngnjo7v7nifgxshsa