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Application of a High-Flow Nasal Cannula for Prevention of Postextubation Atelectasis in Children Undergoing Surgery:
Ji-Hyun Lee1, Sang-Hwan Ji, Young-Eun Jang
1From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Insights
High-flow nasal cannula (HFNC) therapy effectively reduces postoperative atelectasis in infants and children. This method improves lung ultrasound scores and prevents significant lung collapse compared to conventional oxygen therapy.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Medical Imaging
Background:
- General anesthesia commonly causes atelectasis, increasing the risk of pulmonary complications post-surgery.
- Persistent postoperative atelectasis is a significant concern in pediatric patients.
Purpose of the Study:
- To assess the efficacy of high-flow nasal cannula (HFNC) in preventing postoperative atelectasis.
- To evaluate the impact of HFNC on respiratory complications in infants and small children.
Main Methods:
- A prospective randomized controlled trial involving children (≤2 years) undergoing general anesthesia (>2 hours).
- Comparison between a control group receiving conventional oxygen therapy and an HFNC group receiving oxygen via HFNC (2 L kg-1 min-1).
- Lung ultrasound evaluations were performed post-surgery and before PACU discharge to assess atelectasis and lung ultrasound scores.
Main Results:
- No significant difference in lung ultrasound scores or atelectasis incidence at the end of surgery between groups.
- The HFNC group demonstrated a significantly lower consolidation score (0 vs 3; P<.001) and no significant atelectasis at PACU discharge (0% vs 15.8%; P=.011).
- Incidence of desaturation, postoperative complications, and hospital stay did not differ between the groups.
Conclusions:
- Postoperative HFNC use significantly improves lung ultrasound scores.
- HFNC effectively reduces postoperative atelectasis in infants and small children compared to conventional oxygen therapy.
- HFNC is a promising preventive strategy for managing postoperative lung complications in pediatric patients.
Background:
General anesthesia-induced atelectasis is common, and persistent postoperative atelectasis is associated with pulmonary complications. We aimed to evaluate the preventive effects of a high-flow nasal cannula (HFNC) on postoperative atelectasis and respiratory complications in infants and small children.
Methods:
In this prospective randomized controlled trial, children (≤2 years) receiving general anesthesia (>2 hours) were randomized into the control and HFNC groups. At the end of the surgery, the first lung ultrasound evaluation was performed in both groups. In the postanesthetic care unit (PACU), the control group received conventional oxygen therapy, while the HFNC group received oxygen via HFNC, with a flow rate of 2 L kg-1 min-1. Before discharge to the ward, a second lung ultrasound examination was performed. The primary outcome was the lung ultrasound score at PACU discharge. The secondary outcomes included the lung ultrasound score at the end of surgery, the incidence of significant atelectasis at PACU discharge, and other postoperative outcomes.
Results:
Lung ultrasound score and the incidence of atelectasis at the end of surgery did not differ significantly between the control (n = 38) and HFNC (n = 40) groups. After staying in the PACU, both groups showed a reduced lung ultrasound score and atelectasis incidence. However, the HFNC group had a significantly lower consolidation score than the control group (0; interquartile range [IQR] = 0-1 vs 3; IQR = 2-4; P< .001). Additionally, none of the patients had significant atelectasis in the HFNC group, compared to 6 patients in the control group (0% vs 15.8%; odds ratio [OR] = 0.444; 95% confidence interval for OR, 0.343-0.575; P = .011). Incidence of desaturation (oxygen saturation [Spo2] ≤ 95%), postoperative complications, and the length of hospital stay did not differ between the groups.
Conclusions:
Preventive use of HFNC after surgery improves the lung ultrasound score and reduces postoperative atelectasis compared to conventional oxygen therapy in infants and small children.
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