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Prophylactic Postoperative High Flow Nasal Oxygen Versus Conventional Oxygen Therapy in Obese Patients Undergoing Bariatric Surgery (OXYBAR Study): a Pilot Randomised Controlled Trial

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Abstract

Background

Patients with obesity are predisposed to a reduction in end-expiratory lung volume (EELV) and atelectasis after anaesthesia. High flow nasal oxygen (HFNO) may increase EELV, reducing the likelihood of postoperative pulmonary complications (PPC). We conducted a pilot randomised controlled trial (RCT) of conventional oxygen therapy versus HFNO after bariatric surgery. The aim was to investigate the feasibility of using electrical impedance tomography (EIT) as a means of assessing respiratory mechanics and to inform the design of a definitive RCT.

Methods

We performed a single-centre, parallel-group, pilot RCT. Adult patients with obesity undergoing elective bariatric surgery were eligible for inclusion. We excluded patients with a known contraindication to HFNO or with chronic lung disease.

Results

Fifty patients were randomised in equal proportions. One patient crossed over from conventional O2 to HFNO. Delta EELI was higher at 1 hour in patients receiving HFNO (mean difference = 831 Au (95% CI − 1636–3298), p = 0.5). Continuous EIT beyond 1 hour was poorly tolerated. At 6 hours, there were no differences in PaO2/FiO2 ratio or PaCO2. Only one patient developed a PPC (in the HFNO group) by 6 weeks.

Conclusions

These data suggest that a large-scale RCT of HFNO after bariatric surgery in an ‘all-comers’ population is likely infeasible. While EIT was an effective means of assessing respiratory mechanics, it was impractical over time. Similarly, the infrequency of PPC precludes its use as a primary outcome. Future studies should focus on identifying patients at the greatest risk of PPC.

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Funding

The study was funded by Wesley Medical Research (Australia).

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Authors and Affiliations

  1. Department of Anaesthesia and Critical Care, Queen Elizabeth II University Hospital, Glasgow, UK

    Rachel Fulton

  2. Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, Queensland, 4032, Australia

    Rachel Fulton, Jonathan E. Millar, Amanda Corley, Jonathon P. Fanning & John F. Fraser

  3. Faculty of Medicine, University of Queensland, Brisbane, Australia

    Jonathan E. Millar, Ivan L. Rapchuk, Jonathon P. Fanning & John F. Fraser

  4. Roslin Institute, University of Edinburgh, Edinburgh, UK

    Jonathan E. Millar

  5. St. Andrew’s War Memorial Hospital, Brisbane, Australia

    Megan Merza, Helen Johnston, Daniel Faulke, Ivan L. Rapchuk, Joe Tarpey, Philip Lockie & Shirley Lockie

  6. Griffith University, Griffith, Australia

    Amanda Corley

Authors
  1. Rachel Fulton
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  2. Jonathan E. Millar
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  3. Megan Merza
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  4. Helen Johnston
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  5. Amanda Corley
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  6. Daniel Faulke
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  7. Ivan L. Rapchuk
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  11. Shirley Lockie
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  12. John F. Fraser
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Corresponding author

Correspondence to John F. Fraser.

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Conflict of Interest

The study received grant funding from Wesley Medical Research (Australia). The corresponding author has received travel and research support from Fisher & Paykel Pty Ltd. Rachel Fulton has no conflict of interest. Jonathan Millar has received honoraria from Fisher & Paykel Pty Ltd for an educational activity. Megan Merza and Helen Johnston have no conflict of interest. Amanda Corley has received honoraria from Fisher & Paykel Pty Ltd for an educational activity. Daniel Faulke, Ivan Rapchuk, Joe Tarpey, Jonathon Fanning, Philip Lockie, and Shirley Lockie have no conflict of interest. John Fraser has received honoraria from Fisher & Paykel Ltd. For educational activity and research support unrelated to this study. Fisher & Paykel Pty Ltd were not involved in the conception, design, or analysis of this study.

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Key Points

• HFNO failed to produce a significant increase in EELI at 60 min.

• The use of HFNO was not associated with improvements in PaO2/FiO2 ratio, dyspnoea, length of stay, or the incidence of postoperative pulmonary complications. However, the incidence of PPC was low.

• The use of HFNO was associated with higher pain scores at 6 hours.

• Based on these data, a large-scale RCT of HFNO after bariatric surgery in an ‘all-comers’ population is likely infeasible.

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Fulton, R., Millar, J.E., Merza, M. et al. Prophylactic Postoperative High Flow Nasal Oxygen Versus Conventional Oxygen Therapy in Obese Patients Undergoing Bariatric Surgery (OXYBAR Study): a Pilot Randomised Controlled Trial. OBES SURG 31, 4799–4807 (2021). https://doi.org/10.1007/s11695-021-05644-y

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  • DOI: https://doi.org/10.1007/s11695-021-05644-y

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