High-Flow Nasal Cannula in Weaning Patients from Mechanical Ventilation in Head and Neck Surgery: Retrospective Study

Background: Patients undergoing head and neck surgery with free flap reconstruction are at a high risk for postoperative respiratory complications, including hypoxemia. Conventional oxygen therapy (COT) and non-invasive ventilation (NIV) may be poorly tolerated or contraindicated due to anatomical limitations. High-Flow Nasal Cannula (HFNC) therapy represents a promising alternative, offering better humidification, comfort, and oxygenation. Methods: This retrospective single-center study included 50 adult patients admitted to the ICU after head and neck oncologic surgery with flap reconstruction from January 2022 to November 2024. All patients received HFNC immediately after extubation. Hypoxemia was defined as a PaO₂/FiO₂ (P/F) ratio of < 300 mm Hg. The primary outcome was the incidence of postoperative hypoxemia. Secondary outcomes included reintubation rates and patient compliance. Data were collected at 1, 6, 12, and 24 h following HFNC initiation. Results: Out of 59 patients screened, 9 were excluded per predefined criteria. Among the 50 included, only 2 patients (4%) developed hypoxemia, with P/F ratios remaining above 250. No patients required reintubation. The respiratory rate-oxygenation index (ROX index) improved steadily during the first 24 h. HFNC was well tolerated; only three patients required minor adjustments due to discomfort. Conclusions: HFNC use in the immediate postoperative period after head and neck surgery was associated with a low incidence of hypoxemia and no reintubations. These findings suggest that HFNC is a safe and effective strategy for postoperative respiratory support in this high-risk population. Further prospective studies are warranted to confirm the benefit of HFNC in reducing hypoxemia and preventing reintubation in high-risk surgical populations.