Effect Of High-flow Nasal Cannula Oxygen Therapy Compared With Conventional Oxygen Therapy After Adult Cardiothoracic Surgery:A Meta-analysis

Objective:The effects of high flow nasal cannula(HFNC)on adult patients after cardiothoracic surgery remain controversial.We conducted a meta-analysis of randomized controlled trials(RCTs)to evaluate the effect of HFNC compared with conventional oxygen therapy(COT)on post-cardiothoracic surgery.Methods:A search was conducted of the PubMed,Embase,Web of Science,Cochrane libraries,Wan fang and How Net databases for all the controlled study comparing HFNC with COT in adult patients after cardiothoracic surgery.Two authors independently selected and extracted data and assessed the quality of each study.The meta-analysis was performed by using RevMan 5.3.The primary outcome was the rate of reintubation,the rate of escalation of respiratory support and pulmonary complications;secondary outcomes included the length of ICU stay and length of hospital stay.Results:Nine studies that involved 1034 patients were included in the analysis.No significant heterogeneity was found in outcome measures.Compared with COT,HFNC significantly reduced the reintubation rate(OR=0.25,95%CI=0.15~0.52,P<0.05)and the rate of escalation of respiratory support(OR=0.39,95%CI=0.27~0.55,P<0.0001)and shorten hospital stay(MD=-0.24,95%CI=-0.46~-0.02,P=0.03)。There were no significant differences in the pulmonary complications and length of intensive care unit stay in the 2 groups.No severe complications were reported in either group.The results of the subgroup analysis showed that HFNC had a lower reintubation rate after lung surgery.HFNC is superior to COT in the need for escalation of respiratory support and reducing hospital stay after cardiac surgery.There was no significant difference in the ICU stay time between the two oxygen therapy methods after cardiac and lung surgery.Conclusions:The HFNC could significantly reduce the reintubation rate,the need for escalation ofrespiratory support and shorten hospital stay.There were no differences in the pulmonary complications and the length of ICU stay compared with COT,it could be safely administered in adult after cardiothoracic surgery.HFNC is superior to COT in the need for escalation of respiratory support and reducing hospital stay after cardiac surgery.There was no significant difference in the ICU stay time between the two oxygen therapy methods after cardiac and lung surgery.Further Large-scale,high-quality randomized controlled trials are needed to update this finding.