# High‐Flow Nasal Cannula Versus Conventional Oxygen Therapy in Patients Undergoing Thoracic Surgery: A Randomized Controlled Trial

## TL;DR

A study found that high-flow nasal cannula oxygen therapy during thoracic surgery did not significantly reduce postoperative lung complications compared to standard oxygen therapy.

## Contribution

The study is the first to evaluate HFNC's efficacy in reducing PPC during thoracic surgery, focusing on perioperative oxygenation and respiratory effort.

## Key findings

- HFNC did not significantly reduce PPC incidence compared to conventional oxygen therapy (20.0% vs. 26.7%).
- Chronic obstructive pulmonary disease and surgery duration over 2 hours were independent predictors of PPC.
- No significant differences were found in hypoxemia, mortality, or ICU admission rates between groups.

## Abstract

Postoperative pulmonary complications (PPC) are linked to higher morbidity and healthcare costs. High‐flow nasal cannula (HFNC) oxygen therapy may mitigate PPC by enhancing oxygenation and easing respiratory effort. This study assessed HFNC's efficacy versus conventional oxygen therapy in reducing PPC during anesthetic induction and extubation in elective thoracic surgery for lung resection.

In a single‐center randomized clinical trial, 90 patients undergoing elective thoracic surgery were randomized (1:1) to HFNC or conventional oxygen therapy during induction and extubation. The primary outcome was in‐hospital PPC incidence within 30 days. Secondary outcomes included intubation hypoxemia, 30‐day mortality, and ICU admission. Poisson regression identified PPC predictors.

PPC rates were 20.0% in the HFNC group and 26.7% in controls (relative risk [RR] 0.75, 95% CI 0.35–1.60, p = 0.455), with no significant difference. Poisson regression revealed independent predictors: chronic obstructive pulmonary disease, preoperative SpO2 ≤ 94%, surgery > 2 h, and left lung ventilation (p < 0.05). No differences occurred in intubation hypoxemia (0% both groups), 30‐day mortality (2.22% HFNC vs. 4.44% controls, p = 0.553), or ICU admission (13.33% HFNC vs. 17.78% controls, p = 0.526). HFNC was well‐tolerated without device issues.

HFNC, applied during intubation and extubation, did not significantly reduce the incidence of PPC or secondary outcomes compared to conventional oxygen therapy in patients undergoing elective thoracic surgery. Further research is needed to explore HFNC's potential in high‐risk populations or with optimized protocols, such as extended application periods or varied flow rates, to enhance perioperative respiratory management.

Short‐term perioperative high‐flow nasal cannula (HFNC) oxygen therapy, applied during anesthetic induction and for 30 min post‐extubation, did not significantly reduce postoperative pulmonary complications compared to conventional oxygen therapy in patients undergoing elective thoracic lung resection surgery.