Effect of High-Flow Nasal Cannula Oxygen Therapy on Hypoxemia in Patients After Esophagectomy

TL;DR

High-flow nasal cannula oxygen therapy improves oxygen levels and reduces complications in patients after esophagectomy compared to standard oxygen therapy.

Contribution

Demonstrates that high-flow nasal cannula therapy is more effective than conventional oxygen therapy in post-esophagectomy patients with hypoxemia.

Findings

HFNC therapy improved oxygenation and reduced carbon dioxide levels more effectively than conventional oxygen therapy.

HFNC therapy significantly lowered infection markers like C-reactive protein and neutrophil count.

HFNC therapy reduced the risk of postoperative pneumonia compared to conventional oxygen therapy.

Abstract

Background: Patients with esophageal cancer (EC) who have undergone esophagectomy are at risk of developing hypoxemia and encountering postoperative complications. It is essential to ascertain whether the high-flow nasal cannula (HFNC) therapy offers superior clinical efficacy compared to conventional oxygen therapy (COT).

Methods: Clinical data from 80 patients who experienced hypoxemia subsequent to radical esophagectomy were retrospectively collected at our institution spanning January 2020 to December 2022. The whole cohort was divided into two groups: the HFNC group and the COT group. Following oxygen administration, we evaluated the variations in arterial blood gas parameters and infection indices within each group, in addition to scrutinizing the occurrence of postoperative pulmonary complications.

Results: The HFNC group was associated with a better oxygenation index (Fgroup=41.779, p < 0.001) and partial pressure of carbon dioxide (Fgroup=16.760, p < 0.001) compared with the COT group. Moreover, there were statistically significant differences in the reduction of C-reactive protein (Fgroup = 17.603, p < 0.001) and neutrophil count (Fgroup = 4.395, p=0.039) in the HFNC group compared with the COT group after 3 days of oxygen therapy. Notably, patients treated with HFNC exhibited a markedly reduced risk of developing postoperative complications, especially pneumonia (p=0.039).

Conclusion: HFNC outperformed COT in enhancing oxygenation and reducing carbon dioxide levels and infection indices among patients with hypoxemia after radical resection of EC and also lowered the risk of postoperative pneumonia.

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