High-flow nasal cannula therapy versus conventional oxygen therapy for adult patients after cardiac surgery: A systemic review and meta-analysis

Background

Oxygen therapy constitutes a crucial element of post-cardiac operative care. The study assessed the effectiveness of high-flow nasal cannula (HFNC) in comparison to conventional oxygen therapy (COT).

Objectives

The aim of the study was to assess the effectiveness of HFNC in comparison to COT for adult patients following cardiac surgery.

Methods

We conducted a comprehensive search of Embase, PubMed, Scopus, Cochrane Library, and Web of Science databases from inception until April 18, 2023, to identify randomized controlled trials (RCTs) and crossover studies that compared the efficacy of HFNC with COT in adult patients following cardiac surgery.

Results

The meta-analysis included nine studies, consisting of eight RCTs and one crossover study. Compared with COT, HFNC could reduce the need for escalation of respiratory support (RR 0.67, 95% CI: 0.48 to 0.93, P = 0.02), decrease arterial partial pressure of carbon dioxide (PaCO₂) levels (MD -3.14, 95% CI: -4.90 to -1.39, P<0.001), and increase forced expiratory volume in 1 second (FEV₁) levels (MD 0.08, 95% CI: 0.02 to 0.15, P = 0.02). There was no significant difference between the HFNC and COT groups in terms of mortality, intubation rate, respiratory rate, heart rate, intensive care unit and hospital length of stay, arterial partial pressure of oxygen (PaO₂), forced vital capacity, and complications of atrial fibrillation and delirium.

Conclusion

Compared with COT, HFNC could decrease the need for escalation of respiratory support, lower PaCO₂ levels, and elevate FEV₁ levels in patients following cardiac surgery.