Impact of Prophylactic High Flow Nasal Oxygen in Post-Operative Thoracic Surgical Patients

Study Overview
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Brief Summary
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The Investigators goal was to study the effect of high flow nasal cannula oxygen (HFNC) on the rate of post-operative pulmonary complications in thoracic surgical patients. The Investigators hypothesis is that prophylactic HFNC oxygen, as compared to standard oxygen treatment, will reduce the incidence of postoperative pulmonary complications, improve post-operative pulmonary function, and reduce Intensive Care Unit (ICU) and hospital length of stay.

Detailed Description
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The Investigators goal was to study the effect of high flow nasal cannula oxygen (HFNC) on the rate of post-operative pulmonary complications in thoracic surgical patients. The Investigators hypothesis is that prophylactic HFNC oxygen, as compared to standard oxygen treatment, will reduce the incidence of postoperative pulmonary complications, improve post-operative pulmonary function, and reduce ICU and hospital length of stay.

Official Title
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Impact of Prophylactic High Flow Nasal Oxygen in Post-Operative Thoracic Surgical Patients

Conditions
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Post-operative Pulmonary Complications

Intervention / Treatment
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* Device: Heated humified high-flow nasal cannula Oxygen
* Other: Standard oxygen therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Undergoing Thoracic surgery Planned admission to ICU after surgery Exclusion Criteria: Younger than 18 Pregnant Breast feeding Known diagnosis of obstructive sleep apnea Current or previous lung transplant Pneumonectomy Home oxygen greater than 4L/minute Inability to adhere to assigned treatment prior to 48 hours of surgery or until transferred to a floor

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Heated humidified high-flow nasal cannula (HHFNC) oxygen<br>The intervention group received HHFNC O2 at a set flow of 40L/min. FiO2 was titrated by respiratory therapists to maintain SpO2 ≥ 90%. The HHFNC O2 apparatus included: 1) Air-Oxygen blender - capable of delivering 21-100% FiO2 at flow rates up to 60L/min, 2) Heated Humidifier - providing active heating and humidification to the delivered air-O2 blend, 3) Nasal cannula - larger diameter, slightly elongated nasal cannula with single limb connection to humidifier | Device: Heated humified high-flow nasal cannula Oxygen<br> <br> |
| Active Comparator: Standard oxygen Therapy<br>The standard O2 treatment group received usual nasal cannula or face mask oxygen titrated by nurses as necessary to maintain SpO2 ≥ 90%. | Other: Standard oxygen therapy<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Post-operative Pulmonary Complications | The primary outcome post-operative pulmonary complication is defined as present if any one of the following criteria are met: SpO2 < 90% with FiO2 ≥ 50% Dyspnea at rest Respiratory rate > 25 breaths/min Active use of accessory respiratory muscles PaO2/FiO2 ratio < 200 Escalation of therapy to non-invasive ventilation Re-intubation Occurrence of hospital-acquired pneumonia Re-admission to the ICU | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital Length of Stay | length of stay from hospital admission to hospital discharge | 30 days | 
| Lowest Oxygen Saturation Level Measured | Lowest oxygen saturation level measured during hospitalization from admission to discharge | 30 days | 
| ICU Length of Stay |  | 30 days |