High-Flow Nasal Oxygen vs Noninvasive Positive Airway Pressure in Hypoxemic Patients After Cardiothoracic Surgery

Abstract

After cardiothoracic surgery, acute respiratory failure is common and associated with increased morbidity and mortality.^1,2 When low-flow oxygen therapy is insufficient to correct hypoxemia, noninvasive ventilation is often used to avoid reintubation and improve outcomes,^3-7 notably as a preventive or curative intervention after cardiothoracic surgery.^4,5 A moderate level of evidence (grade 2) supports noninvasive ventilation to treat postoperative respiratory failure.⁸ However, this technique is difficult to implement, requires substantial resources, and may cause patient discomfort.^7-10 It fails in approximately 20% of patients after cardiothoracic surgery, who then require reintubation.^2,7,11,12 High-flow nasal oxygen therapy involves the continuous delivery of up to 60 L/min through a nasal cannula, with optimal heat and humidity. It is increasingly used because of ease of application, patient tolerance, and theoretical clinical benefits^13-15 and may constitute an important alternative to noninvasive ventilation.