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Efficacy of prophylactic high-flow nasal cannula therapy for postoperative pulmonary complications after pediatric cardiac surgery: a prospective single-arm study

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A Letter to the Editor to this article was published on 19 May 2023

Abstract

Purpose

This study investigated the incidence of postoperative pulmonary complications (PPC) when high-flow nasal cannula therapy (HFNC) is used prophylactically after pediatric cardiac surgery, and evaluated its efficacy.

Methods

This was a single-arm prospective interventional study that was conducted in a tertiary teaching hospital with eight beds in the pediatric cardiac ICU after approval by the Ethics Committee. One-hundred children under the age of 48 months who were scheduled for cardiac surgery for congenital heart disease were recruited. HFNC was used for 24 h after extubation at a 2 L/kg/min flow rate. The primary outcome was the incidence of PPC within 48 h after extubation. PPC was defined as atelectasis and acute respiratory failure meeting certain criteria. We considered prophylactic HFNC as effective if the prevalence of PPC was < 10%, based on previous reports of reintubation rates of 6%–9% after pediatric cardiac surgery.

Results

A total of 91 patients were finally included in the analysis. The incidence of PPC within 48 h after extubation was 18.7%, whereas atelectasis was observed in 13.2%, and acute respiratory failure in 8.8%. Reintubation rate within 48 h after extubation was 0%.

Conclusions

We found the incidence of PPC with prophylactic HFNC after planned extubation after pediatric cardiac surgery. However, the incidence was > 10%; therefore, we could not demonstrate its efficacy in this single-arm study. Further studies are needed to investigate whether the HFNC could be adapted as first-line oxygen therapy after pediatric cardiac surgery.

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Data availability

All data analyzed during this study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2–5–1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan

    Tatsuhiko Shimizu, Tomoyuki Kanazawa, Takanobu Sakura, Kazuyoshi Shimizu, Tatsuo Iwasaki & Hiroshi Morimatsu

  2. Department of Anesthesia and Intensive Care, National Cancer Center Hospital, Tokyo, Japan

    Naohiro Shioji

  3. Department of Radiology, Kurashiki Medical Center, Okayama, Japan

    Ryuichiro Fukuhara

  4. Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

    Takayoshi Shinya

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  1. Tatsuhiko Shimizu
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Contributions

TS performed the statistical analyses and wrote the manuscript. TK conducted the research process, performed data collection, and managed the research activity. NS designed the study, conducted the research process, and performed data collection. TS, KS, RF, TS, and TI performed the investigation process. HM supervised the research activity. All authors revised the manuscript critically and approved the final version of the manuscript to be published.

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Correspondence to Tomoyuki Kanazawa.

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Shimizu, T., Kanazawa, T., Sakura, T. et al. Efficacy of prophylactic high-flow nasal cannula therapy for postoperative pulmonary complications after pediatric cardiac surgery: a prospective single-arm study. J Anesth 37, 433–441 (2023). https://doi.org/10.1007/s00540-023-03187-3

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  • DOI: https://doi.org/10.1007/s00540-023-03187-3

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