High-Flow Nasal Oxygen Therapy After Cardiac Surgery: A Randomized Clinical Trial

Area of Science:

• Cardiology
• Pulmonology
• Critical Care Medicine

Background:

• High-flow nasal oxygen therapy (HFNOT) is frequently used for noninvasive respiratory support post-cardiac surgery.
• Its clinical effectiveness and cost-benefit remain uncertain, prompting further investigation.

Purpose of the Study:

• To evaluate the clinical benefits of prophylactic HFNOT versus standard oxygen therapy (SOT).
• To assess HFNOT's impact on patients at increased risk of respiratory complications after cardiac surgery.

Main Methods:

• An adaptive, parallel-group, randomized clinical trial involving 17 centers across 3 countries.
• 1280 adult patients undergoing nonemergent cardiac surgery with pulmonary complication risk factors were randomized 1:1 to HFNOT or SOT.
• The primary outcome was days alive and at home (DAH) without increased support within 90 days (DAH90).

Main Results:

• The median DAH90 was 0 in both the HFNOT and SOT groups (median difference, 0; P=.75).
• No significant differences were observed in the primary effectiveness outcome or secondary clinical outcomes between the groups.
• 1224 patients (95.6%) had complete DAH90 data.

Conclusions:

• Prophylactic HFNOT did not improve DAH90 without increased support in high-risk cardiac surgery patients.
• Current findings do not support the routine implementation of HFNOT after cardiac surgery.
• Further research may explore specific patient subgroups or alternative respiratory support strategies.