RT Journal Article
SR Electronic
T1 High-Flow Nasal Cannula Therapy Versus Intermittent Noninvasive Ventilation in Obese Subjects After Cardiothoracic Surgery
JF Respiratory Care
FD American Association for Respiratory Care
SP 1193
OP 1202
DO 10.4187/respcare.05473
VO 62
IS 9
A1 Stéphan, François
A1 Bérard, Laurence
A1 Rézaiguia-Delclaux, Saida
A1 Amaru, Priscilla
A1 
YR 2017
UL http://rc.rcjournal.com/content/62/9/1193.abstract
AB BACKGROUND: Obese patients are considered at risk of respiratory failure after cardiothoracic surgery. High-flow nasal cannula has demonstrated its non-inferiority after cardiothoracic surgery compared to noninvasive ventilation (NIV), which is the recommended treatment in obese patients. We hypothesized that NIV was superior to high-flow nasal cannula for preventing or resolving acute respiratory failure after cardiothoracic surgery in this population.METHODS: We performed a post hoc analysis of a randomized, controlled trial. Obese subjects were randomly assigned to receive NIV for at least 4 h/d (inspiratory pressure, 8 cm H2O; expiratory pressure, 4 cm H2O; FIO2, 0.5) or high-flow nasal cannula delivered continuously (flow, 50 L/min, FIO2 0.5).RESULTS: Treatment failure (defined as re-intubation, switch to the other treatment, or premature discontinuation) occurred in 21 of 136 (15.4%, 95% CI 9.8–22.6%) subjects with NIV compared to 18 of 135 (13.3%, 95% CI 8.1–20.3%) subjects with high-flow nasal cannula (P = .62). No significant differences were found for dyspnea and comfort scores. Skin breakdown was significantly more common with NIV after 24 h (9.2%, 95% CI 5.0–16.0 vs 1.6%, 95% CI 1.0–6.0; P = .01). No significant differences were found for ICU mortality (5.9% for subjects with NIV vs 2.2% for subjects with high-flow nasal cannula, P = .22) or for any of the other secondary outcomes.CONCLUSIONS: Among obese cardiothoracic surgery subjects with or without respiratory failure, the use of continuous high-flow nasal cannula compared to intermittent NIV (8/4 cm H2O) did not result in a worse rate of treatment failure. Because high-flow nasal cannula presents some advantages, it may be used instead of NIV in obese patients after cardiothoracic surgery.