Hostname: page-component-669899f699-7xsfk Total loading time: 0 Render date: 2025-04-30T05:18:56.723Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of high-flow nasal oxygen therapy on postoperative atelectasis and reintubation rate after paediatric cardiac surgery

Published online by Cambridge University Press:  04 October 2024

Erkut Öztürk Open the ORCID record for Erkut Öztürk [Opens in a new window] ,
Isa Ozyilmaz ,
Ezgi Direnç Yücel ,
Berra Zümrüt Tan Recep ,
İbrahim Cansaran Tanidir Open the ORCID record for İbrahim Cansaran Tanidir [Opens in a new window]  and
Ali Can Hatemi
Erkut Öztürk*
Affiliation:
Department of Pediatric Cardiology, Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, İstanbul, Turkey
Isa Ozyilmaz
Affiliation:
Department of Pediatric Cardiology, Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, İstanbul, Turkey
Ezgi Direnç Yücel
Affiliation:
Department of Anaesthesiology and Reanimation, Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
Berra Zümrüt Tan Recep
Affiliation:
Department of Pediatric Cardiovascular Surgery, Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
İbrahim Cansaran Tanidir
Affiliation:
Department of Pediatric Cardiology, Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, İstanbul, Turkey
Ali Can Hatemi
Affiliation:
Department of Pediatric Cardiovascular Surgery, Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey
*
Corresponding author: Erkut Öztürk; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Airway problems emerging after congenital cardiac surgery operations may have an impact on mortality and morbidity. Recently, to improve alveolar gas exchange and reduce respiratory effort, high-flow nasal cannula (HFNC) has started to be used in paediatric cases. This study aimed to evaluate the potential effects of high-flow nasal oxygen therapy on postoperative atelectasis development and reintubation rate in paediatric cardiac surgery patients.

Methods:

This study was conducted retrospectively in term newborns and infants younger than six months of age who underwent congenital cardiac surgery operation from 1 November 2022 to 1 November 2023 and were followed in the paediatric cardiac ICU. Patients who were receiving mechanical ventilator support at least 12 hours postoperatively were evaluated for the development of postoperative atelectasis and reintubation in the first 3 days of extubation. The patients were grouped as HFNC and non-HFNC users. Demographic characteristics, surgery type, and ICU clinical follow-up data were obtained from medical records. The results were statistically evaluated.

Results:

A total of 40 patients who did not use HFNC in the early postoperative period and 40 patients with HFNC in the late period during the study period were included in the study. The median age was 1 month (IQR 15 days–2 months) with equal gender distribution. Among patients, 70% of them were in the neonatal age group. Reintubation rates in the first 72 hours in HFNC users and non-HFNC users were 2.5% and 12.5%, respectively (p < 0.05). The median postoperative atelectasis scores at 24, 48, and 72 hours of extubation were 2 versus 2.5 (p > 0.05), 1.5 versus 3.5 (p < 0.05), and 1 versus 3 (p < 0.05) in HFNC users and non-HFNC users, respectively.

Conclusion:

HFNC therapy may have a positive effect on preventing atelectasis and reducing the reintubation rate in the early postoperative period.

Keywords

High-flow oxygen therapychildrencongenital cardiac surgeryintensive careearly extubationatelectasis
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 10 , October 2024 , pp. 2178 - 2181
Check for updates
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Khalil, M, Jux, C, Rueblinger, L, Behrje, J, Esmaeili, A, Schranz, D. Acute therapy of newborns with critical congenital heart disease. Transl Pediatr 2019; 8: 114–126.CrossRefGoogle ScholarPubMed
Tirotta, CF, Alcos, S, Lagueruela, RG et al. Three-year experience with immediate extubation in pediatric patients after congenital cardiac surgery. J Cardiothorac Surg 2020; 15: 1–7.CrossRefGoogle ScholarPubMed
Von ungern Sternberg, BS, Petak, F, Saudan, S et al.Effect of cardiopulmonary bypass and aortic clamping on functional residual capacity and ventilation distribution in children. J Thorac Cardiovasc Surg 2007; 134: 1193–1198.CrossRefGoogle ScholarPubMed
Magnusson, L, Zemgulis, V, Wicky, S, et al. Atelectasis is a major cause of hypoxemia and shunt after cardiopulmonary bypass: an experimental study. Anesthesiology 1997; 87: 1153–1163.CrossRefGoogle Scholar
Ozturk, E, Tanidir, IC, Haydin, S, Onan, IS, Odemis, E, Bakir, I. The use of dornase alpha for post-operative pulmonary atelectasis after congenital heart surgery. Cardiol Young 2014; 24: 807–812.CrossRefGoogle ScholarPubMed
Kumar, A, Joshi, S, Tiwari, N et al. Comparative evaluation of high-flow nasal cannula oxygenation vs nasal intermittent ventilation in postoperative paediatric patients operated for acyanotic congenital cardiac defects. Med J Armed Forces India 2022; 78: 454–462.CrossRefGoogle ScholarPubMed
Manley, BJ, Owen, LS, Doyle, LW et al. High-flow nasal cannulae in very preterm infants after extubation. N Engl J Med 2013; 10: 1425–1433.CrossRefGoogle Scholar
Shioji, N, Kanazawa, T, Iwasaki, T et al. High-flow nasal cannula versus noninvasive ventilation for postextubation acute respiratory failure after pediatric cardiac surgery. Acta Med Okayama 2019; 73: 15–20.Google ScholarPubMed
Larrazabal, LA, del Nido, PJ, Jenkins, KJ et al. Measurement of technical performance in congenital heart surgery: a pilot study. Ann Thorac Surg 2007; 83: 179–184.CrossRefGoogle ScholarPubMed
Hendriks, T, de Hoog, M, Lequin, MH, Devos, AS, Merkus, PJ. DNase and atelectasis in non-cystic fibrosis pediatric patients. Crit Care 2005; 9: R351–R356.CrossRefGoogle ScholarPubMed
Gupta, P, Rettiganti, M, Gossett, JM et al. Risk factors for mechanical ventilation and reintubation after pediatric heart surgery. J Thorac Cardiovasc Surg 2016; 151: 451–458.e3.CrossRefGoogle ScholarPubMed
Gaies, M, Tabbutt, S, Schwartz, SM et al. Clinical epidemiology of extubation failure in the pediatric cardiac ICU: A report from the pediatric cardiac critical care consortium. Pediatr Crit Care Med 2015; 16: 837–845.CrossRefGoogle ScholarPubMed
Brainard, J, Scott, BK, Sullivan, BL et al. Heated humidified high-flow nasal cannula oxygen after thoracic surgery - a randomized prospective clinical pilot trial. J Crit Care 2017; 40: 225–228.CrossRefGoogle ScholarPubMed
Zheng, YR, Chen, XH, Zhou, SJ. Application of high-flow nasal cannula in fibreoptic bronchoscopy after congenital heart surgery: a retrospective cohort study. BMJ Paediatr Open 2023; 7: e001870.CrossRefGoogle ScholarPubMed
Kamerkar, A, Hotz, J, Morzov, R, Newth, CJL, Ross, PA, Khemani, RG. Comparison of effort of breathing for infants on nasal modes of respiratory support. J Pediatr 2017; 185: 26–32.e3.CrossRefGoogle ScholarPubMed
Iyer, NP, Rotta, AT, Essouri, S et al. Association of extubation failure rates with high-flow nasal cannula, continuous positive airway pressure, and bilevel positive airway pressure vs conventional oxygen therapy in infants and young children: a systematic review and network meta-analysis. JAMA Pediatr 2023; 177: 774–781.CrossRefGoogle ScholarPubMed
Zhou, SJ, Chen, XH, Liu, YY, Chen, Q, Zheng, YR, Zhang, QL. Comparison of high-flow nasal cannula oxygenation and non-invasive ventilation for postoperative pediatric cardiac surgery: a meta-analysis. BMC Pulm Med 2024; 24: 92.CrossRefGoogle ScholarPubMed
Bennyworth, BD, Mastropietro, CW, Graham, EM et al. Variation in extubation failure rates after neonatal congenital heart surgery across pediatric cardiac critical care consortium hospital. J Thorac Cardiovasc Surg 2017; 153: 1519–1526.CrossRefGoogle Scholar