[Nasal high-flow therapy in a patient with postanesthetic hypoxia after tracheal extubation]

A 63-year-old female with obesity (body mass index of 32.0 kg x m(-2)) was scheduled for total abdominal hysterectomy under combined epidural general anesthesia. The surgical procedure was completed without any troubles. Immediately after tracheal extubation, however, the patient developed acute respiratory distress, and the percutaneous oxygen saturation (Spo2) decreased from 97 to 44% for 1 minute. When the patient was admitted to our intensive care unit due to hypoxia, arterial blood gas values showed pH 7.37, Paco2 40.4 mmHg, Pao2 67.5 mmHg, and Spo2 94% on 5 l x min(-1) of oxygen via face mask. Her respiratory rate was 23 breaths x min(-1). We used a nasal high-flow humidified oxygen system (Optiflow) to improve oxygenation. We set the initial flow rate at 35 l x min(-1) with 50% oxygen. One hour after initiating the nasal high-flow system, the patient's respiratory rate fell to 18 breaths x min(-1), and Spo2 rose up to 98%. Arterial blood gas showed improved Pao2 of 98.0 mmHg. Nasal high-flow therapy was useful to avoid intubation in a patient with postanesthetic respiratory failure.