Effect of early post-extubation high-flow nasal cannula versus conventional low-flow oxygen therapy on reintubation in postoperative patients from prolonged general anesthesia at surgical ICU: A randomized clinical trial (Protocol)

High versus low flow oxygen therapy after extubation in prolonged general anesthesia patients

Authors

  • Sirichai Phetuthairung Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 10700
  • Suneerat Kongsayreepong Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 10700

DOI:

https://doi.org/10.54205/ccc.v31.260850

Keywords:

High flow nasal cannula, Oxygen therapy, Reintubation, Postoperative pulmonary complications, Prolonged general anesthesia

Abstract

Background: The main concerns following general anesthesia, especially if it lasts longer than 4 hours, are postoperative pulmonary complications, including hypoxemia, lung atelectasis, and acute respiratory failure requiring reintubation. To avoid these complications, postoperative extubation with respiratory support is crucial. The high-flow nasal cannula (HFNC) increases end-expiratory lung volume and reduces the work of breathing to improve oxygenation by delivering a flow-dependent positive airway pressure. The advantages of using HFNC to prevent reintubation have been demonstrated in patients undergoing cardiothoracic surgery. Our target population's information is still deficient, and our trial is set up to uncover this proof.

Objectives: To evaluate the effect of high-flow nasal cannula (HFNC) versus low-flow nasal cannula on the reintubation rate and clinical outcomes in the early post-extubation adult who has prolonged general anesthesia for non-cardiothoracic and non-neuro surgery that requires surgical ICU admission.

Methods: In this study, 260 patients with an intermediate to high risk of postoperative pulmonary complications following non-cardiothoracic surgery and non-neurosurgery that required general anesthesia for longer than 4 hours were randomly assigned to receive either a high-flow nasal cannula (HFNC) or a low-flow nasal cannula after extubation. The primary outcome indicator is the reintubation rate within 72 hours of tracheal extubation. Postoperative pulmonary complications, the length of stay in the ICU and hospital, and mortality are considered secondary outcome measures.

Conclusions: This study is an investigator-initiated randomized controlled trial powered to test the hypothesis that early application of a high-flow nasal cannula probably reduces the reintubation rate in patients in SICUs with prolonged durations of general anesthesia.

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Published

2023-05-09

How to Cite

1.
Phetuthairung S, Kongsayreepong S. Effect of early post-extubation high-flow nasal cannula versus conventional low-flow oxygen therapy on reintubation in postoperative patients from prolonged general anesthesia at surgical ICU: A randomized clinical trial (Protocol): High versus low flow oxygen therapy after extubation in prolonged general anesthesia patients. Clin Crit Care [Internet]. 2023 May 9 [cited 2024 Nov. 12];31(1):2023:e0007. Available from: https://he02.tci-thaijo.org/index.php/ccc/article/view/260850

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Research Protocol