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