Abstract
Background High-flow nasal cannula (HFNC) therapy is increasingly utilized following extubation in patients undergoing cardiac surgery, due to its potential benefits in preventing pulmonary complications such as atelectasis, pleural effusion, and pneumonia. However, the comparative efficacy of HFNC versus conventional oxygen therapy (COT) in elderly patients remains unclear. This study aims to compare post-extubation pulmonary outcomes between HFNC and COT in elderly patients following cardiac surgery.
Methods We conducted a retrospective cohort study at a tertiary care hospital in Southern Thailand, including patients aged 65 and older who underwent elective cardiac surgery between December 2018 and January 2024. The primary outcome was the incidence of post-extubation pulmonary complications (PPCs) within 72 hours. Secondary outcomes included the length of intensive care unit (ICU) and hospital stays, all-cause in-hospital mortality, and atelectasis scores.
Results A total of 424 patients were included, with 212 patients in each group. HFNC therapy was associated with a significant reduction in the odds of bronchospasm (7.5% vs. 24.5%; adjusted OR = 0.22, 95% CI = 0.12–0.41). There were no significant differences between the groups in terms of reintubation rates, tracheostomy, ICU stay, hospital stay, or all-cause mortality. However, atelectasis scores were significantly improved on day 5 post-extubation.
Conclusion HFNC therapy may reduce the incidence of bronchospasms in elderly patients after cardiac surgery and significant improvement of atelectasis score at day 5. While these findings suggest a potential benefit of HFNC in postoperative care, further research is warranted to explore its long-term effects and implications for patient outcomes.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
The author(s) received no specific funding for this work.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
This study was conducted in accordance with the Declaration of Helsinki and was approved by the Human Research Ethics Committee of the Faculty of Medicine at the Prince of Songkla University, Songkhla, Thailand (Ethics Committee reference number: REC.66-526-8-1). Informed consent was obtained prior to data collection.
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
Data Availability
All relevant data are within the manuscript and its Supporting Information files.
