Research ArticleNew Horizons Symposium

Management of Postoperative Hypoxemia

Kai Liu, J Brady Scott, Guoqiang Jing and Jie Li
Respiratory Care July 2021, 66 (7) 1136-1149; DOI: https://doi.org/10.4187/respcare.08929

Abstract

Hypoxemia is common in postoperative patients and is associated with prolonged hospital stays, high costs, and increased mortality. This review discusses the postoperative management of hypoxemia in regard to the use of conventional oxygen therapy, high-flow nasal cannula oxygen therapy, CPAP, and noninvasive ventilation. The recommendations made are based on the currently available evidence.

Introduction

Hypoxemia is common in postoperative patients and mainly caused by atelectasis, ventilation/perfusion mismatch, or pulmonary edema. Postoperative hypoxemia is associated with increased mortality, prolonged hospital stays, and increased costs, especially in patients who have multiple risk factors.1-4 Patients at risk often face prolonged respiratory support and re-intubation, which leads to poor overall outcomes. There is current evidence that early identification of risk factors of postoperative hypoxemia is imperative for the prevention or treatment of the condition. The purpose of this paper is to discuss pertinent findings from recent publications that pertain to postoperative management of hypoxemia. The recommendations are made based on the current evidence (Fig. 1).

Fig. 1.
Fig. 1.

Algorithm for respiratory support in postoperative patients. SBT = spontaneous breathing trial; NIV = noninvasive ventilation; HFNC = high-flow nasal cannula.

Incidence and Outcome of Postoperative Hypoxemia

The incidence of postoperative hypoxemia ranges from 3% to 65%, depending on definitions, the presence of risk factors, and type of surgery.2,4-6 Postoperative hypoxemia was variably defined in the publications included in this review. Definitions were a peripheral capillary oxygen saturation (Embedded Image) value of <93% on room air, or the ratio of the Embedded Image/Embedded Image of < 300 mm Hg.7 Severe postoperative hypoxemia was defined as the need for an Embedded Image of 1.0 to maintain Embedded Image ≥ 85%.8 However, recorded Embedded Image values might underestimate the severity of postoperative hypoxemia if done manually and periodically. Sun et al9 used the Embedded Image data that were recorded by a monitor at 1-min intervals in 833 postoperative adult subjects. More than one-fifth of the subjects in their study were found to have a Embedded Image < 90% for >10 min/h.9 The inconsistent use of definitions in research papers and variable practices that relate to pulse oximetry complicates the understanding of the incidence of postoperative hypoxemia.

Postoperative hypoxemia has been reported to compromise wound healing and cause other severe complications, such as brain dysfunction, dysrhythmias, and myocardial ischemia. These complications are particularly noted within the first week after surgery. Of the 1,202 subjects with abdominal, orthopedic, and neurologic procedures reported by Fernandez-Bustamante et al,10 19.6% required prolonged oxygen therapy, whereas 17.1% developed atelectasis. These subjects also had significantly more ICU admissions, a longer ICU and/or hospital stay, and higher early mortality. Moderate and severe postoperative hypoxemia within the first 3 postoperative days has also been shown to be independently associated with increased postoperative mortality at 1 year.4 Therefore, prevention and management of postoperative hypoxemia is necessary to improve patient outcomes.

Etiologies and Risk Factors of Postoperative Hypoxemia

The etiologies of postoperative hypoxemia include reduced chest wall and diaphragmatic activity caused by surgical-site pain, hemodynamic impairment, and anesthetic drugs. These factors may lead to ventilation/perfusion mismatch and alveolar hypoventilation.11 Risk factors for postoperative hypoxemia are generally categorized as patient related or surgery related (Fig. 2). Understanding and identifying these risk factors can aid in the selection of appropriate respiratory care interventions.

Fig. 2.
Fig. 2.

Risk factors of postoperative hypoxemia. BMI = body mass index; OSA = obstructive sleep apnea; ASA = American Society of Anesthesiology; CABG = coronary artery bypass grafting; aTAAD = acute Stanford A aortic dissection.

Patients who are morbidly obese, with a body mass index (BMI) > 30 kg/m2, experience more frequent oxygen desaturation episodes after surgery compared with patients with normal weight.12 Patients with obstructive sleep apnea are at high risk of developing postoperative hypoxemia due to hypoventilation.13 These subjects with a preoperative apnea-hypopnea index of ≥ 15 were reported to be independently associated with postoperative hypoxima.14 Other patient-related risk factors include being elderly (generally > 65 years), an American Society of Anesthesiology physical status classification of IV, a preoperative dependent-living status, preoperative sepsis, moderate-to-severe cardiorespiratory disease, ineffective cough or poor lung function, and history of heavy smoking (>10 pack-years).15

In general, high-risk surgeries that are associated with the development of postoperative hypoxemia include brain, aortic, cardiac, thoracic, and upper abdominal surgery.2 In addition to the surgical procedures themselves, other risk factors contribute to the development of hypoxemia. Preoperative acute myocardial infarction and elevated free fatty acid concentrations are risk factors of postoperative hypoxemia after a coronary artery bypass grafting procedure.16-19 In the subjects who underwent an acute Stanford A aortic dissection surgery, preoperative Embedded Image/Embedded Image ≤ 300 mm Hg, long cardiac arrest time, and massive blood transfusion (after surgery, >6 units in 24 h or >3,000 mL) were predictors of postoperative hypoxemia.20,21 In the subjects after surgical aortic valve replacement, age, COPD, congestive heart failure, and bleeding disorders were associated with 30-d re-intubation.22 Similarly, in subjects after thoracic surgery, American Society of Anesthesiology physical status classification of ≥ III, surgery duration > 80 min, fluid balance during operation > 4,000 mL were found to be independent risk factors of postoperative hypoxemia.23-28 During abdominal surgery, including hepatectomy, upper or upper and lower (vs lower) abdominal incision, multiple procedures (vs one), crystalloid replacement > 6 L, and total surgery duration > 5 h were found to be risk factors.29-31

Efforts to predict the likelihood of postoperative pulmonary complications have been made. Canet et al32 developed a scoring tool, the ARISCAT (assessed respiratory risk in surgical patients in Catalonia) score, to predict postoperative pulmonary complications based on their surgical cohort. Components of this score include age, preoperative Embedded Image and hemoglobin, previous respiratory infection within 1 month of surgery, surgical incision (abdominal or intrathoracic), surgery duration, and planned versus emergency status of the surgery; the risk level was considered as moderate with an ARISCAT score ≥ 26.32 This scoring tool has been used in several randomized controlled trials (RCTs) that sought to better understand how to prevent or manage postoperative hypoxemia. To the best of our knowledge, a scoring tool specific for the prediction of postoperative hypoxemia has not yet been published.

Prophylactic Versus Curative Use of Respiratory Support for Postoperative Patients

Oxygen therapy has been recommended in the perioperative period to reduce surgical-site infections by the World Health Organization.33 In postoperative patients, standard O2 therapy, such as low-flow nasal cannula, a simple face mask, or an air-entrainment mask is routinely applied after extubation. In recent years, high-flow nasal cannula (HFNC) oxygen therapy has been increasingly used for postoperative patients after extubation. HFNC oxygen therapy provides a constant Embedded Image and generates some degree of PEEP and has been shown to improve oxygenation for patients who are hypoxemic.34 The PEEP generated by HFNC is variable and depends on gas-flow settings, nasal cannula size, the patient’s breathing pattern, and whether the mouth is open or closed.35 In contrast, CPAP and noninvasive ventilation (NIV) provide constant positive airway pressure, which recruits alveoli or maintains alveolar recruitment. By providing 2 levels of positive pressure, NIV augments tidal volume and reduces the work of breathing. Importantly, both CPAP and NIV can be used for patients who tend to mouth breathe because they can be connected with an oronasal mask, total face mask, or helmet. An important consideration with regard to respiratory support devices is timing. Respiratory support can be given prophylactically as a way to prevent extubation failure or curatively when signs of respiratory compromise are apparent. In addition, respiratory support can be provided as a way to facilitate extubation in patients at high risk, such as those with COPD.

Prophylactic Use of HFNC Versus Standard O2 Therapy Versus NIV or CPAP

The aim of the prophylactic use of respiratory support is to reduce pulmonary complications, prevent respiratory failure, and avoid re-intubation.36 Ten RCTs assessed the effects of HFNC and standard O2 therapy in preventing respiratory failure and re-intubation in the immediate postoperative period (Table 1).37-46 Of the 10 RCTs, 5 were conducted in subjects after cardiac surgery,37-41 and 4 were conducted in subjects after thoracic surgery.42-45 Only one trial was completed in subjects after major thoracic and abdominal surgery.46 In the most recent systematic review and meta-analysis, which included these 10 RCTs, HFNC was associated with significant reductions in re-intubation and escalation of respiratory support when compared with standard O2 therapy.7 These effects were noted in cardiothoracic subjects, and a post hoc subgroup analysis suggested that the subjects with high-risk factors such as BMI ≥ 30 kg/m2, ARISCAT score ≥ 26, or chronic pulmonary disease benefited the most from HFNC.7 There were no significant effects on other important clinical outcomes, such as mortality, ICU length of stay, and hospital length of stay. The prophylactic use of HFNC was recommended in patients with high-risk factors after cardiothoracic surgery (Fig. 1). When considering that the only RCT of the subjects who underwent abdominal surgery did not find any significant differences between HFNC and standard O2 therapy;46 currently, no recommendation is made for patients after abdominal surgery.

View this table:
Table 1.

Characteristics of Randomized Control Trials With Postextubation Preventive Use: HFNC vs Standard O2 Therapy

Similarly, multiple RCTs compared the prophylactic use of NIV or CPAP versus standard O2 therapy for postoperative subjects (Table 2), but all were completed before 2009 and most were the comparison of CPAP versus standard O2 therapy.47-66 Of the 20 RCTs, only 5 reported re-intubation rates,56,59,60,64,66 in which one compared CPAP and standard O2 therapy.56 In the CPAP versus standard O2 therapy study, no significant differences in re-intubation rates were found. In the remaining 4 studies,59,60,64,66 2 studies compared the continuous versus intermittent use of CPAP and found lower re-intubation rates with continuous CPAP;59,60 however, the clinical implication of this finding was questionable due to the concerns of patient comfort and complications of continuous CPAP, for example, skin breakdown. In addition, the low incidence of re-intubation rates in those subjects is also of concern. In the study reported by Zarbock et al,60 the re-intubation rates were reduced from 2.5% to 1.3% by using continuous CPAP, which might not be clinically meaningful.

View this table:
Table 2.

RCTs Comparing the Prophylactic Use of NIV or CPAP vs Standard O2 Therapy Immediately Postextubation for Postoperative Subjects

Stéphan et al67 conducted a unique RCT to compare HFNC with NIV for subjects after cardiothoracic surgery, who were divided into 3 groups: 1) subjects who passed a spontaneous breathing trial (SBT) and had one of 3 high-risk factors (BMI > 30 kg/m2, left-ventricular ejection fraction of <40%, or failure of previous extubation); 2) subjects who passed an SBT but developed hypoxemic respiratory failure after extubation; 3) subjects in whom an SBT failed but were still extubated. Randomization was stratified based on the 3 groups. Interestingly, even though the outcomes between the 2 overall groups were not significantly different, the subgroup analysis on the prophylactic use of HFNC versus NIV for the subjects with high-risk factors showed lower rates of treatment failure in the HFNC group (5.7% vs 12.6%; P =.04).67 This result might be explained by the better compliance and longer use of HFNC than NIV due to patient comfort and convenience with the 2 devices. This is the only RCT that compared the prophylactic use of HFNC with NIV for subjects after surgery. Future RCTs with larger sample size are needed to confirm this finding.

Curative Use of NIV or CPAP Versus Standard O2 Therapy Versus HFNC

In a recently published European Society of Anaesthesiology and European Society of Intensive Care Medicine guideline,68 compared with standard O2 therapy, NIV or CPAP is recommended to treat patients with perioperative or periprocedural hypoxemia to improve oxygenation. So far, 8 RCTs compared the use of NIV or CPAP and standard O2 therapy in subjects after surgery who had already developed hypoxemic respiratory failure (Table 3).69-76 Of the 8 studies, 5 were completed in subjects after cardiothoracic surgery70-72,74,76 and 3 were completed in subjects who underwent abdominal surgery.69,73,75 NIV was used in 6 RCTs and significantly reduced the re-intubation rates in the subjects after cardiothoracic or abdominal surgery.69-74 Interestingly, Yang et al74 compared the use of NIV with a helmet versus an oronasal mask versus standard O2 therapy in their subjects after Stanford type-A aortic dissection; only NIV with the helmet was found to significantly reduce re-intubation rates compared to standard O2 therapy. Conversely, no significant difference was found between the groups that used NIV with oronasal mask and standard O2 therapy. The superiority of the helmet over the oronasal mask agrees with the findings by Patel et al77 that the lower intubation rate was found in the group of subjects with acute hypoxemia and receiving NIV via the helmet than those receiving NIV via the oronasal mask. However, its benefits in postoperative patients with hypoxemic respiratory failure still need future studies with larger sample sizes to confirm.

View this table:
Table 3.

RCTs Compared the Curative Use of NIV or CPAP and Standard O2 Therapy in Postoperative Subjects Who Developed Hypoxemic ARF

Only 2 RCTs compared CPAP with standard O2 therapy.75,76 No significant differences were found in the re-intubation rates of subjects after cardiac surgery, with a Embedded Image/Embedded Image of 100–250 mm Hg.76 In contrast, Squadrone et al75 found a lower re-intubation rate with CPAP compared with standard O2 therapy in 209 subjects who developed hypoxemia within 1 h after abdominal surgery. Using CPAP in patients who have undergone gastrointestinal surgery should be done cautiously due to the concerns of anastomotic leakage caused by gas aspiration. The findings from the 2 RCTs might suggest that CPAP is most effective as a preventive strategy rather than a therapeutic modality.75,76 It seems that, for patients who develop hypoxemic respiratory failure after cardiothoracic or abdominal surgery, NIV reduces re-intubation rates compared with standard O2 therapy (Fig. 1) and NIV with the helmet might be more beneficial than an oronasal mask. The early use of CPAP might be helpful but only in patients after abdominal surgery.

To our knowledge, no study has been done to compare the use of HFNC and standard O2 therapy to treat postoperative patients with hypoxemic respiratory failure. As reported in the aforementioned section, one of the 3 subgroups in the RCT by Stéphan et al67 compared the curative use of HFNC and NIV for subjects after cardiothoracic surgery in whom extubation failed, no significant differences of treatment failure rates were found between HFNC and NIV (27.4% vs 27.8%; P = .93). This suggests that HFNC might be considered as an alternative to NIV to treat hypoxemic respiratory failure in patients who undergo cardiothoracic surgery, especially for those who do not tolerate NIV.

Facilitative Extubation With NIV Versus HFNC

Patients in whom traditional weaning attempts fail usually continue invasive ventilation until passing an SBT. However, the risks of continuing invasive ventilation are significant for some patients, such as those that are immunocompromised.68 Thus, early extubation for those patients might play an important role in their outcomes.36 The European Respiratory Society and American Thoracic Society guideline78 suggests using NIV to facilitate weaning from invasive ventilation in patients with hypercapnic respiratory failure, whereas no recommendation was provided for patients who are hypoxemic. Recently, Vaschetto et al79 conducted an RCT in a group of highly selected subjects who were hypoxemic and found that early extubation followed by immediate NIV application reduced the days on invasive ventilation without affecting the length of ICU stay.

Similarly, in a historical comparison study implemented by Liu et al,80 early extubation followed by subsequent NIV significantly reduced the duration of invasive ventilation and the length of ICU stay in postoperative subjects in whom the first SBT failed. A small subgroup of postoperative subjects in the Stéphan et al67 RCT were evaluated on the effects of NIV versus HFNC to facilitate weaning in postoperative patients. A trend toward higher treatment failure was found in patients who were extubated to HFNC versus those who were treated with NIV (40.7% vs 28.0%; P = .33). The evidence supporting early extubation to NIV after surgery is still lacking. The use of NIV to facilitate early extubation for postoperative patients in whom an SBT failed should be done so with caution.

Optimize Respiratory Support

Appropriate settings to achieve optimal treatment effects are essential for treatment success when respiratory support is used. For patients who developed atelectasis after cardiac surgery, Pasquina et al66 compared the use of NIV and CPAP in an RCT, and found that more subjects in the NIV group had radiologic improvement of atelectasis (60% vs 40%; P = .02). This finding supports the use of inspiratory pressure provided by NIV rather than a constant positive pressure that does not change between the phases of the breath. More importantly, the key to NIV success seems to be sufficient driving pressure. Joris et al48 compared the inspiratory and expiratory positive pressure settings of 12 and 4 cm H2O, respectively, with pressure settings of 8 and 4 cm H2O, and no NIV in subjects with obesity who underwent gastroplasty. They found only the subjects in the NIV settings of 12 and 4 cm H2O had significant improvement in pulmonary function after surgery, whereas no significant differences were found in the groups of NIV setting at 8 and 4 cm H2O and no NIV.48 For the utilization of HFNC, flow settings play a key role in treatment success. However, no consensus has been achieved in the flow settings for patients with different etiologies and situations. Particularly, the individual patient’s inspiratory flow may vary breath by breath. One universal setting does not fit all; an individualized setting and timely adjustment should be considered.

Clinical Monitoring During Respiratory Support

Close monitoring is necessary to ensure the success of respiratory support, particularly the first 1 h of initiating treatment because most patients who improve with treatment will do so within the first hour. Although delaying intubation is associated with increased mortality, escalation of therapy is warranted if the patients do not respond to treatment in the first hour.81 Common monitoring variables include breathing frequency, accessory muscle use, or work of breathing, Embedded Image, and Embedded Image/Embedded Image.11 More recently, the ROX index, defined as the ratio of Embedded Image/Embedded Image to frequency, has been described and prospectively validated to predict the failure of HFNC in patients with acute respiratory failure caused by pneumonia, and the cutoff value was determined as 4.88.82-84 However, the sensitivity and specificity of the ROX index in patients who were hypoxemic after surgery and the threshold to determine HFNC failure require further investigation.

When NIV is used, special attention should be paid to risk factors for NIV failure, such as copious secretions with ineffective cough ability, hemodynamic instability, and the intolerance to the interface or positive pressure. Duan et al85 developed the HACOR score (heart rate, acidosis, consciousness, oxygenation, and respiratory rate) to predict NIV failure among patients who are hypoxemic. The scale seemed effective in predicting NIV failure in a separate cohort of subjects with hypoxemia. An HACOR score > 5 after 1 h use of NIV was a cutoff point to determine NIV failure, and intubation was recommended.

Making the determination of treatment failure and knowing when to escalate therapy, such as endotracheal intubation and mechanical ventilation, are challenging. We summarized the intubation criteria from all the RCTs by comparing HFNC and NIV or CPAP versus standard O2 therapy in Table 4. The most common criteria are 1) tachypnea with a frequency > 35 breaths/min and accessory muscle use; 2) respiratory acidosis, with pH < 7.30 and Embedded Image > 50 mm Hg; 3) altered mental status; 4) hemodynamic instability; and 5) loss of the ability to protect the airway. The only controversial criterion is for refractory hypoxemia, which varies greatly in RCTs.

View this table:
Table 4.

Intubation Criteria Used in the RCTs that Compared HFNC, CPAP, NIV vs Standard O2 Therapy

Other Treatments

Incentive Spirometry

Incentive spirometry (IS) encourages patients to perform deep breathing exercises independently, with visual feedback of inspiratory effort.86 Since the introduction in 1970, IS has been broadly used for postoperative patients to prevent and treat pulmonary complications, such as atelectasis or pneumonia.87,88 However, data with regard to its effectiveness are conflicting, and high-quality evidence is lacking.89 In a recently published systematic review and meta-analysis of 95 RCTs, no significant differences in patient outcomes were found between IS and standard medical care (risk ratio 1.06, 95% CI 0.85–1.34).90 However, in the RCT of subjects after coronary artery bypass grafting, Eltorai et al91 found that the use of IS significantly improved the radiographic atelectasis severity score, the need for NIV, length of stay in the ICU and hospital, and 6-month mortality in a subgroup of subjects after non-elective surgery. Importantly, in this study, a reminder bell was used in the experimental group. This increased adherence to IS when compared with the control group, which had no reminder bell. 91 This finding suggests that using IS correctly may be the key to treatment success. In a large national survey of health-care providers, respondents reported that patients might forget to use their incentive spirometer, which contributed to therapy nonadherence.92 To accurately assess and harness the true value of IS for postoperative patients, efforts aimed at improving IS adherence are warranted.93

Inhaled Pulmonary Vasodilators

Inhaled pulmonary vasodilators have been increasingly used to improve oxygenation for patients with hypoxemia by correcting a ventilation/perfusion mismatch.94 They are also used in patients with hypoxemia and with pulmonary hypertension and/or right heart failure to reduce pulmonary arterial pressure. Small cohort studies demonstrated that inhaled pulmonary vasodilators via HFNC or NIV can reduce pulmonary arterial pressure and/or improve oxygenation in patients after cardiac surgery,95-99 but larger RCTs are needed to validate these findings.100 Inhaled pulmonary vasodilators can improve hypoxemia but did not reverse the underlying condition.

Non-Opioid Analgesics

Adverse events due to respiratory depression often occur on the first postoperative day due to the administration of opioids.101 Non-opioid analgesics have been proposed as a way to control pain while reducing the use of opioids. This would, at least in theory, reduce the incidence of postoperative hypoxemia.101 However, in a recent double-blind RCT with 570 subjects after abdominal surgery, no significant difference in the duration of postoperative hypoxemia was found between the groups of subjects treated with opioids and with non-opioids.102 Future studies are needed to investigate the role of non-opioid analgesics in postoperative hypoxemia.

Areas of Uncertainty and Future Research

Some uncertainties remain in the prevention and management of postoperative hypoxemia. A comprehensive scoring system that uses risk factors specific for postoperative hypoxemia is needed to determine patients at high risk. For those postoperative patients who are considered high risk, the prophylactic use of HFNC versus NIV needs to be determined. The role of HFNC for patients after abdominal surgery compared with standard O2 therapy needs further investigation. For patients for whom a planned extubation failed, whether HFNC or NIV is more effective to prevent re-intubation is still unknown. NIV has theoretic superiority over CPAP for reducing work of breathing and prevention of atelectasis in postoperative patients, but whether this translates to better clinical outcomes is still unclear. The combination of HFNC and NIV, meaning the utilization of HFNC during NIV breaks, has shown to be more effective than NIV alone in reducing re-intubation in nonsurgical patients at high risk.103 Whether this combination has similar benefits in patients after surgery and with high-risk factors warrants further study. Also, whether the combined use of oxygen therapy with adjunct therapy, for example, lung expansion therapy and inhaled pulmonary vasodilators, would generate better outcomes for patients after surgery is unknown.

Summary

Postoperative hypoxemia is common in clinical practice. Compared with patients without postoperative hypoxemia, these patients have longer lengths of stay and higher mortality in an ICU and hospital. Special attention needs to be paid to patients with risk factors, specifically age > 65 years, BMI ≥ 30 kg/m2, American Society of Anesthesiology physical status classification ≥ III, ARISCAT score ≥ 26, preoperative dependent living status, preoperative sepsis, or chronic pulmonary disease such as moderate-to-severe COPD, asthma, or obstructive sleep apnea. Analysis of the currently available evidence suggests that the prophylactic use of HFNC benefits patients at high risk of hypoxemic respiratory failure after cardiothoracic surgery. For patients in whom planned extubation failed after surgery, NIV should be used to treat hypoxemic respiratory failure and to avoid re-intubation, whereas early CPAP should only be considered for patients after abdominal surgery. If a patient is intolerant of NIV or CPAP, HFNC might be considered as an alternative. Close monitoring of the patient’s response to treatment within the first hour of initiation is essential in treatment success and escalation of therapy should be considered when no improvement is observed.

Footnotes

  • Correspondence: Jie Li PhD RRT RRT-ACCS RRT-NPS FAARC, Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, 600 S Paulina St, Suite 765, Chicago, IL 60612. E-mail: jie_li{at}rush.edu

  • Dr Li discloses relationships with Fisher & Paykel Healthcare, Aerogen, Rice Foundation, and the American Association for Respiratory Care. She is also Section Editor for Respiratory Care. Dr Scott discloses a relationship with Teleflex. The remaining authors declare no conflict of interest.

  • Dr Li presented a version of this paper at the New Horizons Symposium: Care of the High Risk Surgical Patient at AARC Congress 2020 LIVE!, held virtually on November 18, 2020.

REFERENCE

  1. 1.↵
    1. Khan NA,
    2. Quan H,
    3. Bugar JM,
    4. Lemaire JB,
    5. Brant R,
    6. Ghali WA
    . Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med 2006;21(2):177-180.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Gupta H,
    2. Gupta PK,
    3. Fang X,
    4. Miller WJ,
    5. Cemaj S,
    6. Forse RA,
    7. et al
    . Development and validation of a risk calculator predicting postoperative respiratory failure. Chest 2011;140(5):1207-1215.
    OpenUrlCrossRefPubMed
  3. 3.
    1. Serpa Neto A,
    2. Hemmes SNT,
    3. Barbas CSV,
    4. Beiderlinden M,
    5. Fernandez-Bustamante A,
    6. Futier E,
    7. et al
    . Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: a systematic review and meta-analysis. Lancet Respir Med 2014;2(12):1007-1015.
    OpenUrl
  4. 4.↵
    1. Bartels K,
    2. Kaizer A,
    3. Jameson L,
    4. Bullard K,
    5. Dingmann C,
    6. Fernandez-Bustamante A
    . Hypoxemia within the first 3 postoperative days is associated with increased 1-year postoperative mortality after adjusting for perioperative opioids and other confounders. Anesth Analg 2020;131(2):555-563.
    OpenUrl
  5. 5.
    1. Xue FS,
    2. Li BW,
    3. Zhang GS,
    4. Liao X,
    5. Zhang YM,
    6. Liu JH,
    7. et al
    . The influence of surgical sites on early postoperative hypoxemia in adults undergoing elective surgery. Anesth Analg 1999;88(1):213-219.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Arozullah AM,
    2. Daley J,
    3. Henderson WG,
    4. Khuri SF
    . Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg 2000;232(2):242-253.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Chaudhuri D,
    2. Granton D,
    3. Wang DX,
    4. Burns KEA,
    5. Helviz Y,
    6. Einav S,
    7. et al
    . High-flow nasal cannula in the immediate postoperative period: a systematic review and meta-analysis. Chest 2020;158(5):1934-1946.
    OpenUrl
  8. 8.↵
    1. Nayyar D,
    2. Man HSJ,
    3. Granton J,
    4. Gupta S
    . Defining and characterizing severe hypoxemia after liver transplantation in hepatopulmonary syndrome. Liver Transpl 2014;20(2):182-190.
    OpenUrlPubMed
  9. 9.↵
    1. Sun Z,
    2. Sessler DI,
    3. Dalton JE,
    4. Devereaux PJ,
    5. Shahinyan A,
    6. Naylor AJ,
    7. et al
    . Postoperative hypoxemia is common and persistent: a prospective blinded observational study. Anesth Analg 2015;121(3):709-715.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Fernandez-Bustamante A,
    2. Frendl G,
    3. Sprung J,
    4. Kor DJ,
    5. Subramaniam B,
    6. Martinez Ruiz R,
    7. et al
    . Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: a multicenter study by the Perioperative Research Network Investigators. JAMA Surg 2017;152(2):157-166.
    OpenUrl
  11. 11.↵
    1. Suzuki S
    . Oxygen administration for postoperative surgical patients: a narrative review. J Intensive Care 2020;8:79.
    OpenUrl
  12. 12.↵
    1. Ahmad S,
    2. Nagle A,
    3. McCarthy RJ,
    4. Fitzgerald PC,
    5. Sullivan JT,
    6. Prystowsky J
    . Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg 2008;107(1):138-143.
    OpenUrlCrossRefPubMed
  13. 13.↵
    1. Kaw R,
    2. Pasupuleti V,
    3. Walker E,
    4. Ramaswamy A,
    5. Foldvary-Schafer N
    . Postoperative complications in patients with obstructive sleep apnea. Chest 2012;141(2):436-441.
    OpenUrlCrossRefPubMed
  14. 14.↵
    1. Suen C,
    2. Ryan CM,
    3. Mubashir T,
    4. Ayas NT,
    5. Abrahamyan L,
    6. Wong J,
    7. et al
    . Sleep study and oximetry parameters for predicting postoperative complications in patients with OSA. Chest 2019;155(4):855-867.
    OpenUrlCrossRef
  15. 15.↵
    1. McAlister FA,
    2. Bertsch K,
    3. Man J,
    4. Bradley J,
    5. Jacka M
    . Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med 2005;171(5):514-517.
    OpenUrlCrossRefPubMed
  16. 16.↵
    1. Hulzebos EHJ,
    2. Van Meeteren NLU,
    3. De Bie RA,
    4. Dagnelie PC,
    5. Helders PJM
    . Prediction of postoperative pulmonary complications on the basis of preoperative risk factors in patients who had undergone coronary artery bypass graft surgery. Phys Ther 2003;83(1):8-16.
    OpenUrlAbstract/FREE Full Text
  17. 17.
    1. Ji Q,
    2. Mei Y,
    3. Wang X,
    4. Feng J,
    5. Cai J,
    6. Sun Y,
    7. et al
    . Study on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Circ J 2008;72(12):1975-1980.
    OpenUrlCrossRefPubMed
  18. 18.
    1. Shi S,
    2. Gao Y,
    3. Wang L,
    4. Liu J,
    5. Yuan Z,
    6. Yu M
    . Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation. J Cardiothorac Surg 2015;10(1):122.
    OpenUrl
  19. 19.↵
    1. Guan Z,
    2. Lv Y,
    3. Liu J,
    4. Liu L,
    5. Yuan H,
    6. Shen X
    . Smoking cessation can reduce the incidence of postoperative hypoxemia after on-pump coronary artery bypass grafting surgery. J Cardiothorac Vasc Anesth 2016;30(6):1545-1549.
    OpenUrl
  20. 20.↵
    1. Wang Y,
    2. Xue S,
    3. Zhu H
    . Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg 2013;8:118.
    OpenUrlCrossRefPubMed
  21. 21.↵
    1. Sheng W,
    2. Yang H-Q,
    3. Chi Y-F,
    4. Niu Z-Z,
    5. Lin MS,
    6. Long S
    . Independent risk factors for hypoxemia after surgery for acute aortic dissection. Saudi Med J 2015;36(8):940-946.
    OpenUrlAbstract/FREE Full Text
  22. 22.↵
    1. Burton BN,
    2. Prophete L,
    3. Carter D,
    4. Betancourt J,
    5. Schmidt UH,
    6. Gabriel RA
    . Demographic and clinical variables associated with 30-day re-intubation following surgical aortic valve replacement. Respir Care 2021;66(2):248-252.
    OpenUrlAbstract/FREE Full Text
  23. 23.↵
    1. Filaire M,
    2. Bedu M,
    3. Naamee A,
    4. Aubreton S,
    5. Vallet L,
    6. Normand B,
    7. Escande G
    . Prediction of hypoxemia and mechanical ventilation after lung resection for cancer. Ann Thorac Surg 1999;67(5):1460-1465.
    OpenUrlCrossRefPubMed
  24. 24.
    1. Stéphan F,
    2. Boucheseiche S,
    3. Hollande J,
    4. Flahault A,
    5. Cheffi A,
    6. Bazelly B,
    7. Bonnet F
    . Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest 2000;118(5):1263-1270.
    OpenUrlCrossRefPubMed
  25. 25.
    1. Møller AM,
    2. Pedersen T,
    3. Svendsen PE,
    4. Engquist A
    . Perioperative risk factors in elective pneumonectomy: the impact of excess fluid balance. Eur J Anaesthesiol 2002;19(1):57-62.
    OpenUrlCrossRefPubMed
  26. 26.
    1. Agostini P,
    2. Cieslik H,
    3. Rathinam S,
    4. Bishay E,
    5. Kalkat MS,
    6. Rajesh PB,
    7. et al
    . Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax 2010;65(9):815-818.
    OpenUrlAbstract/FREE Full Text
  27. 27.
    1. Im Y,
    2. Park HY,
    3. Shin S,
    4. Shin SH,
    5. Lee H,
    6. Ahn JH,
    7. et al
    . Prevalence of and risk factors for pulmonary complications after curative resection in otherwise healthy elderly patients with early stage lung cancer. Respir Res 2019;20(1):136.
    OpenUrl
  28. 28.↵
    1. Ohi M,
    2. Toiyama Y,
    3. Omura Y,
    4. Ichikawa T,
    5. Yasuda H,
    6. Okugawa Y,
    7. et al
    . Risk factors and measures of pulmonary complications after thoracoscopic esophagectomy for esophageal cancer. Surg Today 2019;49(2):176-186.
    OpenUrl
  29. 29.↵
    1. Calligaro KD,
    2. Azurin DJ,
    3. Dougherty MJ,
    4. Dandora R,
    5. Bajgier SM,
    6. Simper S,
    7. et al
    . Pulmonary risk factors of elective abdominal aortic surgery. J Vasc Surg 1993;18(6):914-920; discussion 920–921.
    OpenUrlCrossRefPubMed
  30. 30.
    1. Serejo LGG,
    2. da Silva-Júnior FP,
    3. Bastos JPC,
    4. de Bruin GS,
    5. Mota RMS,
    6. de Bruin PFC
    . Risk factors for pulmonary complications after emergency abdominal surgery. Respir Med 2007;101(4):808-813.
    OpenUrlCrossRefPubMed
  31. 31.↵
    1. Nobili C,
    2. Marzano E,
    3. Oussoultzoglou E,
    4. Rosso E,
    5. Addeo P,
    6. Bachellier P,
    7. et al
    . Multivariate analysis of risk factors for pulmonary complications after hepatic resection. Ann Surg 2012;255(3):540-550.
    OpenUrlPubMed
  32. 32.↵
    1. Canet J,
    2. Gallart L,
    3. Gomar C,
    4. Paluzie G,
    5. Valles J,
    6. Castillo J,
    7. et al
    ; ARISCAT Group. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010;113(6):1338-1350.
    OpenUrlCrossRefPubMed
  33. 33.↵
    1. Allegranzi B,
    2. Zayed B,
    3. Bischoff P,
    4. Kubilay NZ,
    5. de Jonge S,
    6. de Vries F,
    7. et al
    ; WHO Guidelines Development Group. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016;16(12):e288-e303.
    OpenUrlCrossRefPubMed
  34. 34.↵
    1. Li J,
    2. Jing G,
    3. Scott JB
    . Year in review 2019: high-flow nasal cannula oxygen therapy for adult subjects. Respir Care 2020;65(4):545-557.
    OpenUrlAbstract/FREE Full Text
  35. 35.↵
    1. Groves N,
    2. Tobin A
    . High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care 2007;20(4):126-131.
    OpenUrlCrossRefPubMed
  36. 36.↵
    1. Maggiore SM,
    2. Battilana M,
    3. Serano L,
    4. Petrini F
    . Ventilatory support after extubation in critically ill patients. Lancet Respir Med 2018;6(12):948-962.
    OpenUrl
  37. 37.↵
    1. Parke R,
    2. McGuinness S,
    3. Dixon R,
    4. Jull A
    . Open-label, phase II study of routine high-flow nasal oxygen therapy in cardiac surgical patients. Br J Anaesth 2013;111(6):925-931.
    OpenUrlCrossRefPubMed
  38. 38.
    1. Corley A,
    2. Bull T,
    3. Spooner AJ,
    4. Barnett AG,
    5. Fraser JF
    . Direct extubation onto high-flow nasal cannulae post-cardiac surgery versus standard treatment in patients with a BMI ≥ 30: a randomised controlled trial. Intensive Care Med 2015;41(5):887-894.
    OpenUrlPubMed
  39. 39.
    1. Zochios V,
    2. Collier T,
    3. Blaudszun G,
    4. Butchart A,
    5. Earwaker M,
    6. Jones N,
    7. Klein AA
    . The effect of high-flow nasal oxygen on hospital length of stay in cardiac surgical patients at high risk for respiratory complications: a randomised controlled trial. Anaesthesia 2018;73(12):1478-1488.
    OpenUrl
  40. 40.
    1. Sahin M,
    2. El H,
    3. Akkoç I
    . Comparison of mask oxygen therapy and high-flow oxygen therapy after cardiopulmonary bypass in obese patients. Can Respir J 2018;2018:1039635.
    OpenUrl
  41. 41.↵
    1. Tatsuishi W,
    2. Sato T,
    3. Kataoka G,
    4. Sato A,
    5. Asano R,
    6. Nakano K
    . High-flow nasal cannula therapy with early extubation for subjects undergoing off-pump coronary artery bypass graft surgery. Respir Care 2020;65(2):183-190.
    OpenUrlAbstract/FREE Full Text
  42. 42.↵
    1. Ansari BM,
    2. Hogan MP,
    3. Collier TJ,
    4. Baddeley RA,
    5. Scarci M,
    6. Coonar AS,
    7. et al
    . A randomized controlled trial of high-flow nasal oxygen (Optiflow) as part of an enhanced recovery program after lung resection surgery. Ann Thorac Surg 2016;101(2):459-464.
    OpenUrl
  43. 43.
    1. Brainard J,
    2. Scott BK,
    3. Sullivan BL,
    4. Fernandez-Bustamante A,
    5. Piccoli JR,
    6. Gebbink MG,
    7. Bartels K
    . Heated humidified high-flow nasal cannula oxygen after thoracic surgery - a randomized prospective clinical pilot trial. J Crit Care 2017;40:225-228.
    OpenUrl
  44. 44.
    1. Yu Y,
    2. Qian X,
    3. Liu C,
    4. Zhu C
    . Effect of high-flow nasal cannula versus conventional oxygen therapy for patients with thoracoscopic lobectomy after extubation. Can Respir J 2017;2017:7894631.
    OpenUrlCrossRefPubMed
  45. 45.↵
    1. Pennisi MA,
    2. Bello G,
    3. Congedo MT,
    4. Montini L,
    5. Nachira D,
    6. Ferretti GM,
    7. et al
    . Early nasal high-flow versus Venturi mask oxygen therapy after lung resection: a randomized trial. Crit Care 2019;23(1):68.
    OpenUrlPubMed
  46. 46.↵
    1. Futier E,
    2. Paugam-Burtz C,
    3. Godet T,
    4. Khoy-Ear L,
    5. Rozencwajg S,
    6. Delay J-M,
    7. et al
    ; OPERA study investigators. Effect of early postextubation high-flow nasal cannula vs conventional oxygen therapy on hypoxaemia in patients after major abdominal surgery: a French multicentre randomised controlled trial (OPERA). Intensive Care Med 2016;42(12):1888-1898.
    OpenUrlCrossRefPubMed
  47. 47.↵
    1. Aguiló R,
    2. Togores B,
    3. Pons S,
    4. Rubí M,
    5. Barbé F,
    6. Agustí AGN
    . Noninvasive ventilatory support after lung resectional surgery. Chest 1997;112(1):117-121.
    OpenUrlCrossRefPubMed
  48. 48.↵
    1. Joris JL,
    2. Sottiaux TM,
    3. Chiche JD,
    4. Desaive CJ,
    5. Lamy ML
    . Effect of bi-level positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty. Chest 1997;111(3):665-670.
    OpenUrlCrossRefPubMed
  49. 49.
    1. Ebeo CT,
    2. Benotti PN,
    3. Byrd RP Jr.,
    4. Elmaghraby Z,
    5. Lui J
    . The effect of bi-level positive airway pressure on postoperative pulmonary function following gastric surgery for obesity. Respir Med 2002;96(9):672-676.
    OpenUrlCrossRefPubMed
  50. 50.
    1. Perrin C,
    2. Jullien V,
    3. Vénissac N,
    4. Berthier F,
    5. Padovani B,
    6. Guillot F,
    7. et al
    . Prophylactic use of noninvasive ventilation in patients undergoing lung resectional surgery. Respir Med 2007;101(7):1572-1578.
    OpenUrlCrossRefPubMed
  51. 51.
    1. Carlsson C,
    2. Sondén B,
    3. Thylen U
    . Can postoperative continuous positive airway pressure (CPAP) prevent pulmonary complications after abdominal surgery? Intensive Care Med 1981;7(5):225-229.
    OpenUrlCrossRefPubMed
  52. 52.
    1. Lindner KH,
    2. Lotz P,
    3. Ahnefeld FW
    . Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions. Chest 1987;92(1):66-70.
    OpenUrlCrossRefPubMed
  53. 53.
    1. Pinilla JC,
    2. Oleniuk FH,
    3. Tan L,
    4. Rebeyka I,
    5. Tanna N,
    6. Wilkinson A,
    7. Bharadwaj B
    . Use of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery. Crit Care Med 1990;18(8):836-840.
    OpenUrlCrossRefPubMed
  54. 54.
    1. Thomas AN,
    2. Ryan JP,
    3. Doran BR,
    4. Pollard BJ
    . Nasal CPAP after coronary artery surgery. Anaesthesia 1992;47(4):316-319.
    OpenUrlPubMed
  55. 55.
    1. Jousela I,
    2. Räsänen J,
    3. Verkkala K,
    4. Lamminen A,
    5. Mäkeläinen A,
    6. Nikki P
    . Continuous positive airway pressure by mask in patients after coronary surgery. Acta Anaesthesiol Scand 1994;38(4):311-316.
    OpenUrlCrossRefPubMed
  56. 56.↵
    1. Böhner H,
    2. Kindgen-Milles D,
    3. Grust A,
    4. Buhl R,
    5. Lillotte WC,
    6. Müller BT,
    7. et al
    . Prophylactic nasal continuous positive airway pressure after major vascular surgery: results of a prospective randomized trial. Langenbecks Arch Surg 2002;387(1):21-26.
    OpenUrlCrossRefPubMed
  57. 57.
    1. Gaszynski T,
    2. Tokarz A,
    3. Piotrowski D,
    4. Machala W
    . Boussignac CPAP in the postoperative period in morbidly obese patients. Obes Surg 2007;17(4):452-456.
    OpenUrlCrossRefPubMed
  58. 58.
    1. Neligan PJ,
    2. Malhotra G,
    3. Fraser M,
    4. Williams N,
    5. Greenblatt EP,
    6. Cereda M,
    7. Ochroch EA
    . Continuous positive airway pressure via the Boussignac system immediately after extubation improves lung function in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesthesiology 2009;110(4):878-884.
    OpenUrlCrossRefPubMed
  59. 59.↵
    1. Kindgen-Milles D,
    2. Müller E,
    3. Buhl R,
    4. Böhner H,
    5. Ritter D,
    6. Sandmann W,
    7. Tarnow J
    . Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery. Chest 2005;128(2):821-828.
    OpenUrlCrossRefPubMed
  60. 60.↵
    1. Zarbock A,
    2. Mueller E,
    3. Netzer S,
    4. Gabriel A,
    5. Feindt P,
    6. Kindgen-Milles D
    . Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients. Chest 2009;135(5):1252-1259.
    OpenUrlCrossRefPubMed
  61. 61.
    1. Stock MC,
    2. Downs JB,
    3. Gauer PK,
    4. Alster JM,
    5. Imrey PB
    . Prevention of postoperative pulmonary complications with CPAP, incentive spirometry, and conservative therapy. Chest 1985;87(2):151-157.
    OpenUrlCrossRefPubMed
  62. 62.
    1. Ricksten SE,
    2. Bengtsson A,
    3. Soderberg C,
    4. Thorden M,
    5. Kvist H
    . Effects of periodic positive airway pressure by mask on postoperative pulmonary function. Chest 1986;89(6):774-781.
    OpenUrlCrossRefPubMed
  63. 63.
    1. Denehy L,
    2. Carroll S,
    3. Ntoumenopoulos G,
    4. Jenkins S
    . A randomized controlled trial comparing periodic mask CPAP with physiotherapy after abdominal surgery. Physiother Res Int 2001;6(4):236-250.
    OpenUrlCrossRefPubMed
  64. 64.↵
    1. Fagevik Olsén M,
    2. Wennberg E,
    3. Johnsson E,
    4. Josefson K,
    5. Lönroth H,
    6. Lundell L
    . Randomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques. Br J Surg 2002;89(10):1228-1234.
    OpenUrlCrossRefPubMed
  65. 65.
    1. Matte P,
    2. Jacquet L,
    3. Van Dyck M,
    4. Goenen M
    . Effects of conventional physiotherapy, continuous positive airway pressure and non-invasive ventilatory support with bilevel positive airway pressure after coronary artery bypass grafting. Acta Anaesthesiol Scand 2000;44(1):75-81.
    OpenUrlCrossRefPubMed
  66. 66.↵
    1. Pasquina P,
    2. Merlani P,
    3. Granier JM,
    4. Ricou B
    . Continuous positive airway pressure versus noninvasive pressure support ventilation to treat atelectasis after cardiac surgery. Anesth Analg 2004;99(4):1001-1008, table of contents.
    OpenUrlCrossRefPubMed
  67. 67.↵
    1. Stéphan F
    . High-flow nasal oxygen therapy for postextubation acute hypoxemic respiratory failure—reply. JAMA 2015;314(15):1644-1645.
    OpenUrl
  68. 68.↵
    1. Leone M,
    2. Einav S,
    3. Chiumello D,
    4. Constantin J-M,
    5. De Robertis E,
    6. De Abreu MG,
    7. et al
    ; Guideline contributors. Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient: a joint ESA/ESICM guideline. Intensive Care Med 2020;46(4):697-713.
    OpenUrl
  69. 69.↵
    1. Antonelli M,
    2. Conti G,
    3. Bufi M,
    4. Costa MG,
    5. Lappa A,
    6. Rocco M,
    7. et al
    . Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA 2000;283(2):235-241.
    OpenUrlCrossRefPubMed
  70. 70.↵
    1. Auriant I,
    2. Jallot A,
    3. Hervé P,
    4. Cerrina J,
    5. Le Roy Ladurie F,
    6. Fournier JL,
    7. et al
    . Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 2001;164(7):1231-1235.
    OpenUrlCrossRefPubMed
  71. 71.
    1. Michelet P,
    2. D'Journo XB,
    3. Seinaye F,
    4. Forel JM,
    5. Papazian L,
    6. Thomas P
    . Non-invasive ventilation for treatment of postoperative respiratory failure after oesophagectomy. Br J Surg 2009;96(1):54-60.
    OpenUrlCrossRefPubMed
  72. 72.↵
    1. Zhu G-f,
    2. Wang D-j,
    3. Liu S,
    4. Jia M,
    5. Jia S-j
    . Efficacy and safety of noninvasive positive pressure ventilation in the treatment of acute respiratory failure after cardiac surgery. Chin Med J (Engl) 2013;126(23):4463-4469.
    OpenUrlPubMed
  73. 73.↵
    1. Jaber S,
    2. Lescot T,
    3. Futier E,
    4. Paugam-Burtz C,
    5. Seguin P,
    6. Ferrandiere M,
    7. et al
    ; NIVAS Study Group. Effect of noninvasive ventilation on tracheal reintubation among patients with hypoxemic respiratory failure following abdominal surgery: a randomized clinical trial. JAMA 2016;315(13):1345-1353.
    OpenUrlCrossRefPubMed
  74. 74.↵
    1. Yang Y,
    2. Liu N,
    3. Sun L,
    4. Zhou Y,
    5. Yang Y,
    6. Shang W,
    7. Li X
    . Noninvasive positive-pressure ventilation in treatment of hypoxemia after extubation following type-A aortic dissection. J Cardiothorac Vasc Anesth 2016;30(6):1539-1544.
    OpenUrl
  75. 75.↵
    1. Squadrone V,
    2. Coha M,
    3. Cerutti E,
    4. Schellino MM,
    5. Biolino P,
    6. Occella P,
    7. et al
    ; Piedmont Intensive Care Units Network (PICUN). Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA 2005;293(5):589-595.
    OpenUrlCrossRefPubMed
  76. 76.↵
    1. Olper L,
    2. Bignami E,
    3. Di Prima AL,
    4. Albini S,
    5. Nascimbene S,
    6. Cabrini L,
    7. et al
    . Continuous positive airway pressure versus oxygen therapy in the cardiac surgical ward: a randomized trial. J Cardiothorac Vasc Anesth 2017;31(1):115-121.
    OpenUrl
  77. 77.↵
    1. Patel BK,
    2. Wolfe KS,
    3. Pohlman AS,
    4. Hall JB,
    5. Kress JP
    . Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA 2016;315(22):2435-2441.
    OpenUrlCrossRefPubMed
  78. 78.↵
    1. Rochwerg B,
    2. Brochard L,
    3. Elliott MW,
    4. Hess D,
    5. Hill NS,
    6. Nava S,
    7. et al
    . Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017;50(2):1602426.
    OpenUrlAbstract/FREE Full Text
  79. 79.↵
    1. Vaschetto R,
    2. Longhini F,
    3. Persona P,
    4. Ori C,
    5. Stefani G,
    6. Liu S,
    7. et al
    . Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial. Intensive Care Med 2019;45(1):62-71.
    OpenUrl
  80. 80.↵
    1. Liu K,
    2. Hao G-W,
    3. Zheng J-L,
    4. Luo J-C,
    5. Su Y,
    6. Hou J-Y,
    7. et al
    . Effect of sequential noninvasive ventilation on early extubation after acute type A aortic dissection. Respir Care 2020;65(8):1160-1167.
    OpenUrlAbstract/FREE Full Text
  81. 81.↵
    1. Kang BJ,
    2. Koh Y,
    3. Lim C-M,
    4. Huh JW,
    5. Baek S,
    6. Han M,
    7. et al
    . Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med 2015;41(4):623-632.
    OpenUrlCrossRefPubMed
  82. 82.↵
    1. Roca O,
    2. Messika J,
    3. Caralt B,
    4. Garcia-de-Acilu M,
    5. Sztrymf B,
    6. Ricard JD,
    7. et al
    . Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index. J Crit Care 2016;35:200-205.
    OpenUrlPubMed
  83. 83.
    1. Roca O,
    2. Caralt B,
    3. Messika J,
    4. Samper M,
    5. Sztrymf B,
    6. Hernández G,
    7. et al
    . An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med 2019;199(11):1368-1376.
    OpenUrlCrossRefPubMed
  84. 84.↵
    1. Ricard J-D,
    2. Roca O,
    3. Lemiale V,
    4. Corley A,
    5. Braunlich J,
    6. Jones P,
    7. et al
    . Use of nasal high flow oxygen during acute respiratory failure. Intensive Care Med 2020;46(12):2238-2247.
    OpenUrl
  85. 85.↵
    1. Duan J,
    2. Han X,
    3. Bai L,
    4. Zhou L,
    5. Huang S
    . Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med 2017;43(2):192-199.
    OpenUrl
  86. 86.↵
    1. Kotta PA,
    2. Ali JM
    . Incentive spirometry for prevention of postoperative pulmonary complications after thoracic surgery. Respir Care 2021;66(2):327-333.
    OpenUrlAbstract/FREE Full Text
  87. 87.↵
    1. Restrepo RD,
    2. Wettstein R,
    3. Wittnebel L,
    4. Tracy M
    . Incentive spirometry: 2011. Respir Care 2011;56(10):1600-1604.
    OpenUrlAbstract/FREE Full Text
  88. 88.↵
    1. Lumb AB
    . Pre-operative respiratory optimisation: an expert review. Anaesthesia 2019;74(Suppl 1):43-48.
    OpenUrl
  89. 89.↵
    1. Eltorai AEM,
    2. Szabo AL,
    3. Antoci V Jr.,
    4. Ventetuolo CE,
    5. Elias JA,
    6. Daniels AH,
    7. Hess DR
    . Clinical effectiveness of incentive spirometry for the prevention of postoperative pulmonary complications. Respir Care 2018;63(3):347-352.
    OpenUrlAbstract/FREE Full Text
  90. 90.↵
    1. Odor PM,
    2. Bampoe S,
    3. Gilhooly D,
    4. Creagh-Brown B,
    5. Moonesinghe SR
    . Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ 2020;368:m540.
    OpenUrlAbstract/FREE Full Text
  91. 91.↵
    1. Eltorai AEM,
    2. Baird GL,
    3. Eltorai AS,
    4. Healey TT,
    5. Agarwal S,
    6. Ventetuolo CE,
    7. et al
    . Effect of an incentive spirometer patient reminder after coronary artery bypass grafting: a randomized clinical trial. JAMA Surg 2019;154(7):579-588.
    OpenUrl
  92. 92.↵
    1. Eltorai AEM,
    2. Baird GL,
    3. Eltorai AS,
    4. Pangborn J,
    5. Antoci V Jr.,
    6. Cullen HA,
    7. et al
    . Incentive spirometry adherence: a national survey of provider perspectives. Respir Care 2018;63(5):532-537.
    OpenUrlAbstract/FREE Full Text
  93. 93.↵
    1. Chen J,
    2. Eltorai AEM
    . Incentive spirometry after lung resection: the importance of patients' adherence. Ann Thorac Surg 2019;107(3):985.
    OpenUrl
  94. 94.↵
    1. Griffiths MJD,
    2. Evans TW
    . Inhaled nitric oxide therapy in adults. N Engl J Med 2005;353(25):2683-2695.
    OpenUrlCrossRefPubMed
  95. 95.↵
    1. Della RG,
    2. Coccia C
    . Nitric oxide in thoracic surgery. Minerva Anestesiol 2005;71(6):313-318.
    OpenUrlPubMed
  96. 96.
    1. Benedetto M,
    2. Romano R,
    3. Baca G,
    4. Sarridou D,
    5. Fischer A,
    6. Simon A,
    7. Marczin N
    . Inhaled nitric oxide in cardiac surgery: evidence or tradition? Nitric Oxide 2015;49:67-79.
    OpenUrl
  97. 97.
    1. Ma G-G,
    2. Hao G-W,
    3. Lai H,
    4. Yang X-M,
    5. Liu L,
    6. Wang CS,
    7. et al
    . Initial clinical impact of inhaled nitric oxide therapy for refractory hypoxemia following type A acute aortic dissection surgery. J Thorac Dis 2019;11(2):495-504.
    OpenUrl
  98. 98.
    1. Li J,
    2. Harnois LJ,
    3. Markos B,
    4. Roberts KM,
    5. Homoud SA,
    6. Liu J,
    7. et al
    . Epoprostenol delivered via high flow nasal cannula for ICU subjects with severe hypoxemia comorbid with pulmonary hypertension or right heart dysfunction. Pharmaceutics 2019;11(6):281.
    OpenUrl
  99. 99.↵
    1. Li J,
    2. Gurnani PK,
    3. Roberts KM,
    4. Fink JB,
    5. Vines D
    . The clinical impact of flow titration on epoprostenol delivery via high flow nasal cannula for ICU patients with pulmonary hypertension or right ventricular dysfunction: a retrospective cohort comparison study. J Clin Med 2020;9(2):464.
    OpenUrl
  100. 100.↵
    1. Sardo S,
    2. Osawa EA,
    3. Finco G,
    4. Gomes Galas FRB,
    5. de Almeida JP,
    6. Cutuli SL,
    7. et al
    . Nitric oxide in cardiac surgery: a meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth 2018;32(6):2512-2519.
    OpenUrl
  101. 101.↵
    1. Weingarten TN,
    2. Warner LL,
    3. Sprung J
    . Timing of postoperative respiratory emergencies: when do they really occur? Curr Opin Anaesthesiol 2017;30(1):156-162.
    OpenUrl
  102. 102.↵
    1. Turan A,
    2. Essber H,
    3. Saasouh W,
    4. Hovsepyan K,
    5. Makarova N,
    6. Ayad S,
    7. et al
    ; FACTOR Study Group. Effect of intravenous acetaminophen on postoperative hypoxemia after abdominal surgery: the FACTOR randomized clinical trial. JAMA 2020;324(4):350-358.
    OpenUrl
  103. 103.↵
    1. Thille AW,
    2. Muller G,
    3. Gacouin A,
    4. Coudroy R,
    5. Decavele M,
    6. Sonneville R,
    7. et al
    ; HIGH-WEAN Study Group and the REVA Research Network. Effect of postextubation high-flow nasal oxygen with noninvasive ventilation vs high-flow nasal oxygen alone on reintubation among patients at high risk of extubation failure: a randomized clinical trial. JAMA 2019;322(15):1465-1475.
    OpenUrlCrossRefPubMed
Back to top

In this issue

 

Print
Download PDF
Article Alerts
Email Article
Citation Tools

Jump to section

Related Articles

Cited By...

Keywords