A randomized controlled trial to compare the outcome of high-flow oxygen versus conventional oxygen in extubated patients after lung resection

Background
Pulmonary (lung) resection is used for the treatment of pulmonary malignancy, infection, and trauma. In addition, it can be used as a means to diagnose lung diseases. Lung resection procedures include wedge resection, metastasectomy, segmentectomy, lobectomy, and pneumonectomy. Lung resection can be done via either open techniques or video-assisted thoracoscopic surgery.
Objectives
To investigate whether high-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy for reducing hypoxemia and postoperative pulmonary complications in extubated patients after lung resection.
Methods
This study is a randomized controlled trial comparing conventional oxygen to high-flow oxygen after lung resection at the Cardiothoracic Academy, Ain Shams University Hospitals. A total of 180 patients were extubated intraoperatively and transferred to ICU, where they received oxygen therapy to compare the outcomes between the two groups.
Results
Looking for postoperative hypoxemia and pulmonary complications after lung resection in conventional oxygen therapy group revealed the following: nine of 90 patients experienced postoperative hypoxemia, with a percentage of 10%; 13.3% of the patients after conventional oxygen therapy experienced atelectasis; four patients representing 4.4% had postoperative pneumonia; two of the 90 patients were diagnosed as having acute respiratory distress syndrome (ARDS); pulmonary edema was a complication seen in five patients in group 1; seven patients experienced prolonged air leak, representing 7.8%; two patients were in need for endotracheal reintubation in the ICU postoperative among this group of patients; three patients in the control group experienced POAF; and no postoperative mortalities were record among our control group. Regarding our study group, five of 90 patients, representing 5.6% of the patients among this group, experienced postoperative hypoxemia. Overall, 7.8% of the patients after high-flow nasal cannula oxygen experienced atelectasis. Only one patient experienced each of the following: pneumonia, ARDS, reintubation, and pulmonary edema. The patient who experienced ARDS needed to be put on extracorporeal membrane oxygenation (ECMO), where he stayed on it for 6 days till weaning, and then he was discharged safely. A total of six patients experienced prolonged air leak, representing 6.7%, and four of 90 patients in group 2 experienced postoperative atrial fibrillation (POAF). No postoperative mortalities were record among our study group.
Conclusion
When compared with conventional oxygen after lung resection, high-flow nasal oxygen did not reduce the incidence of postoperative hypoxemia nor improved other analyzed outcomes. Further adequately powered investigations in this setting are warranted to establish whether high-flow nasal oxygen may yield clinical benefit on extubated patients after lung resection.