scholarly journals TP6.2.18 Initial experience with routine postoperative nasal high-flow oxygen as part of enhanced recovery following oesophagectomy for cancer

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Martin Nnaji ◽  
Renol Koshy ◽  
Oliver Priest ◽  
Duncan Beardsmore ◽  
Vamshi Jagadesham ◽  
...  
Keyword(s):  
Pulmonary Complication ◽  
Enhanced Recovery ◽  
Significant Risk ◽  
Pulmonary Complications ◽  
High Flow ◽  
University Hospital ◽  
Complication Rates ◽  
Tertiary Referral Centre ◽  
Female Ratio ◽  
High Flow Oxygen

Abstract Introduction Pulmonary complications occur in up to 38% of patients undergoing oesophagectomy and are associated with significant risk of mortality. Nasal high-flow oxygen (NHFO) has previously been shown to reduce respiratory complications following major abdominal surgery, however, its use in oesophagectomy has not previously been assessed. We report our results using NHFO routinely as part of our enhanced recovery protocol (ERP) in consecutive patients undergoing oesophagectomy for cancer at a single tertiary referral centre. Methods We recently incorporated routine postoperative NHFO following oesophagectomy as part of our ERP at Royal Stoke University Hospital. We conducted a prospective study of patients undergoing surgery between November 2019 and September 2020. The primary outcome measure was complications related to delivery of NHFO. Secondary endpoints included rates of pulmonary complications and mortality within 30 days of surgery. Results Fifty patients underwent oesophagectomy during the study period. The median age was 66 years (range 43-78 years) and male to female ratio was 4:1.Majority (49/50) of patients underwent 2-stage oesophagectomy while one underwent 3-stage oesophagectomy. All patients received postoperative NHFO. There were no complications related to NHFO. The 30-day overall pulmonary complication rate was 30%.Of these, 28% developed pneumonia,4% pulmonary embolism,and 2% pleural effusions requiring drainage. There were no deaths within 30 days of surgery. Conclusion Routine postoperative NHFO in consecutive patients undergoing oesophagectomy is safe and feasible with lower pulmonary complication rates than previously reported, leading to better overall outcomes. The value of NHFO in oesophagectomy requires further evaluation in a randomized clinical trial.

Department of Internal Medicine. University Hospital of Patras. Patras.

2022 ◽  
Vol 35 (13) ◽  
Author(s):  
Themistoklis Paraskevas ◽  
Eleousa Oikonomou ◽  
Maria Lagadinou ◽  
Vasileios Karamouzos ◽  
Nikolaos Zareifopoulos ◽  
...  
Keyword(s):  
Oxygen Therapy ◽  
Case Series ◽  
High Flow ◽  
University Hospital ◽  
Current Evidence ◽  
Cochrane Library ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen

Introduction: Oxygen therapy remains the cornerstone for managing patients with severe SARS-CoV-2 infection and several modalities of non-invasive ventilation are used worldwide. High-flow oxygen via nasal canula is one therapeutic option which may in certain cases prevent the need of mechanical ventilation. The aim of this review is to summarize the current evidence on the use of high-flow nasal oxygen in patients with severe SARS-CoV-2 infection.Material and Methods: We conducted a systematic literature search of the databases PubMed and Cochrane Library until April 2021 using the following search terms: “high flow oxygen and COVID-19” and “high flow nasal and COVID-19’’.Results: Twenty-three articles were included in this review, in four of which prone positioning was used as an adjunctive measure. Most of the articles were cohort studies or case series. High-flow nasal oxygen therapy was associated with a reduced need for invasive ventilation compared to conventional oxygen therapy and led to an improvement in secondary clinical outcomes such as length of stay. The efficacy of high-flow nasal oxygen therapy was comparable to that of other non-invasive ventilation options, but its tolerability is likely higher. Failure of this modality was associated with increased mortality.Conclusion: High flow nasal oxygen is an established option for respiratory support in COVID-19 patients. Further investigation is required to quantify its efficacy and utility in preventing the requirement of invasive ventilation.

scholarly journals Limitations of the ARDS criteria during high-flow oxygen or non-invasive ventilation: Evidence from critically ill COVID-19 patients

2021 ◽  
Author(s):  
Michael Hultström ◽  
Ola Hellkvist ◽  
Lucian Covaciu ◽  
Filip Fredén ◽  
Robert Frithiof ◽  
...  
Keyword(s):  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
University Hospital ◽  
Respiratory Support ◽  
Arterial Oxygen ◽  
Invasive Ventilation ◽  
Steady State Condition ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen

Abstract Introduction The ratio of partial pressure of arterial oxygen to inspired oxygen fraction (PaO2/FIO2) during invasive mechanical ventilation (MV) is used as criteria to grade the severity of respiratory failure in acute respiratory distress syndrome (ARDS). During the SARS-CoV2 pandemic the use of PaO2/FIO2 ratio has been increasingly used in non-invasive respiratory support such as high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The grading of hypoxemia in non-invasively ventilated patients is uncertain. The main hypothesis, investigated in this study, was that the PaO2/FIO2 ratio does not change when switching between MV, NIV and HFNC. Methods This was a sub-study of a single-center prospective observational study of patients admitted to the intensive care unit (ICU) at Uppsala University Hospital in Sweden for critical COVID-19. In a steady state condition, the PaO2/FIO2 ratio was recorded before and after any change between two of the studied respiratory support techniques (i.e., HFNC, NIV and MV). Results A total of 148 patients were included in the present analysis. We find that any change in respiratory support from or to HFNC caused a significant change in PaO2/FIO2 ratio (up to 48 mmHg, from HFNC to MV). Changes in respiratory support between NIV and MV did not show consistent change in PaO2/FIO2 ratio. In patients classified as mild to moderate ARDS during MV, the change from HFNC to MV showed a variable increase in PaO2/FIO2 ratio ranging between 52 and 140 mmHg (median of 127 mm Hg). This made prediction of ARDS severity during MV from the apparent ARDS grade during HFNC impossible. Conclusion HFNC is associated with lower PaO2/FIO2 ratio than either NIV or MV in the same patient, while NIV and MV provided similar PaO2/FIO2 and thus ARDS grade by Berlin definition. The large variation of PaO2/FIO2 ratio precludes using ARDS grade as a measure of pulmonary damage during HFNC.

Effect of technologic advancements in radiotherapy on postoperative pulmonary complications after neoadjuvant chemoradiation in esophageal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 110-110
Author(s):  
Bevan H. Myles ◽  
Caimiao Wei ◽  
Ritsuko Komaki ◽  
Ara A. Vaporciyan ◽  
Reza J. Mehran ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Pulmonary Complication ◽  
Neoadjuvant Chemoradiation ◽  
Pulmonary Complications ◽  
Complication Rates ◽  
Postoperative Pulmonary Complications ◽  
Radiation Technology ◽  
3D Crt

110 Background: Although 3D conformal radiation therapy (3D-CRT) is currently the de facto standard for the treatment of esophageal cancers, technologies such as Intensity Modulated Radiation Therapy (IMRT) or Proton Beam Therapy (PBT) are increasingly being used, but the evidence for the clinical benefits of these technologies are lacking. We hypothesized that radiation technology influences perioperative complications in esophageal cancer patients treated with neoadjuvant chemoradiation. Methods: We evaluated 423 patients (3D-CRT (n=208, 1998-2008), IMRT (n=165, 2004-2011), and PBT (n=50, 2006-2011)) treated with surgical resection after chemoradiation from 1998-2011 at M. D. Anderson Cancer Center. Postoperative complications (Pulmonary, GI, cardiac, wound healing) were recorded up to 30 days postoperatively. Kruskal-Wallis tests and Chi-square or Fisher’s exact tests assessed associations between continuous and categorical variables and the radiation technology, respectively. Logistic regression model tested the association between treatment technologies and complications adjusting for other significant patient characteristics. Results: While radiation modality was not significantly associated with postoperative GI (leak, ileus, fistula), cardiac (MI, AF, CHF), and wound complications, there was a significant reduction in postoperative pulmonary complications (ARDS, pleural effusion, respiratory insufficiency, pneumonia) for IMRT compared to 3D-CRT (OR 0.46, 95%CI 0.25, 0.83) and PBT compared to 3D-CRT (OR 0.26, 95%CI 0.09, 0.70), but not when IMRT was compared to PBT (OR 1.74, 95%CI 0.66, 4.61) after adjusting for preRT DLCO level. The median length of hospital stay was also significantly different between treatment modalities (12, 10, and 8 days for 3D-CRT, IMRT, and PBT, respectively, p<0.0001). There was no significant association between treatment year with pulmonary complication rates. Conclusions: Radiation technologies such as IMRT and PBT reduced postoperative pulmonary complication rates compared to 3D-CRT in esophageal cancer patients. This result needs to be confirmed in larger prospective studies.

Surgical Outcome of Colon Interposition in Esophageal Cancer Surgery: Analysis of Risk Factors for Conduit-Related Morbidity

2017 ◽  
Vol 66 (05) ◽  
pp. 384-389 ◽  
Author(s):  
Kanghoon Lee ◽  
Seung-Il Park ◽  
Dong Kim ◽  
Yong-Hee Kim ◽  
Se Choi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Graft Failure ◽  
Postoperative Morbidity ◽  
Neoadjuvant Chemoradiotherapy ◽  
Significant Risk ◽  
Pulmonary Complications ◽  
Colon Interposition ◽  
Esophageal Reconstruction ◽  
Survival Duration ◽  
Complication Rates

Background We aimed to assess the feasibility, surgical outcomes, and conduit-related complications of colon interposition in patients with esophageal cancer. Methods Patients with esophageal cancer who underwent colon interposition for esophageal reconstruction between June 2000 and June 2013 were retrospectively reviewed. Results A total of 67 consecutive patients (mean age, 62.2 ± 7.9 years) were enrolled. During this time period, 944 patients underwent esophageal reconstruction using gastric conduit. Twelve patients (17.9%) also received neoadjuvant chemoradiotherapy (nCRT). The median follow-up duration was 44 months (range, 1–168 months); median survival duration was 63 months (range, 1–168 months); and 3- and 5-year overall survival rates were 61.6 and 49.4%, respectively. A total of 43 patients (64.2%) experienced at least 1 postoperative morbidity. According to the Clavien–Dindo grading system, 36 patients (54%) experienced postoperative morbidity of higher than Grade III. Pulmonary complications were most commonly observed complications among the patients (18 patients, 26.9%). Anastomosis site leakage developed in 11 patients (16.4%), and 3 of these patients (6.0%) eventually experienced graft failure. On multivariate analysis, nCRT was determined as a significant risk factor for conduit-related complications (leakage, graft failure, fistula, and stricture). Conclusion Colon interposition is associated with relatively high complication rates, whereas nCRT is associated with conduit morbidity.

scholarly journals 382. Incidence of Hospital-Acquired and Ventilator-Associated Pneumonia in Patients with Severe COVID 19 on High Flow Oxygen

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S260-S261
Author(s):  
Aikaterini Papamanoli ◽  
Jacquelyn Nakamura ◽  
Jenny Fung ◽  
Joshua Abata ◽  
Nikitha Karkala ◽  
...  
Keyword(s):  
Length Of Stay ◽  
High Flow ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Systemic Corticosteroids ◽  
High Flow Oxygen ◽  
Venturi Mask ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
The Impact

Abstract Background Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) can be serious complications of coronavirus disease 19 (COVID-19). Co-infections may worsen outcomes and prolong hospitalization. This risk may be exacerbated by systemic corticosteroids (steroids) and other adjunctive therapies. Methods We reviewed the records of all adults admitted to Stony Brook University Hospital, NY, from 3/1 to 4/15, 2020 with severe COVID-19 pneumonia, requiring high-flow O2 (non-rebreather mask, Venturi mask with FiO2 &gt;50%, or high-flow nasal cannula). We excluded patients who received mechanical ventilation (MV) or died within 24h. Patients were followed until death or hospital discharge. We reviewed positive sputum cultures (PSC) for pathogenic microorganisms and calculated the incidence of HAP and VAP (nosocomial pneumonia, [NP]), rates of MV and impact on mortality. Fungi isolated from sputum, were considered colonization unless associated with fungemia. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on HAP or VAP. Results A total of 469 patients were included (Table 1). Of these, 199 (42.4%) required intensive care and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 105 (22.4%) had PSC. Of these, 59 were considered true pathogens (HAP: 11, VAP: 48), with predominance of S. aureus (MSSA) 38.9%, Enterobacteriaceae 33.8% and Pseudomonas species 18.6%. 39 isolates were considered colonization (Table 2); Patients with PSC &lt; 48h (N=7) from admission, were not considered NP. The incidence of NP was 7.0 per 1000 patient-days (95%CI 5.5–8.5). Of 11 patients with HAP, 9 needed MV. NP was more frequent among patients receiving steroids (9.0 vs 5.7 per 1000 patient-days; P=0.023). Use of tocilizumab was not associated with NP (6.2 vs 8.4 per 1000 patient-days; P=0.11). Mortality was nonsignificantly higher in patients with (20/59, 33.9%) vs. without (103/410, 25.1%) NP (P=0.16). Intubation and length of stay were the strongest predictors of NP in multivariable models. Cohort Characteristics of Patients with Severe COVID -19 Pneumonia on High Flow Oxygen (N= 469) All Microbes Isolated from Sputum Cultures Conclusion Among high risk COVID-19 patients, NP is a common complication. MSSA and Enterobacteriaceae were the most frequent isolates. The risk increases with intubation, longer hospital stay and use of steroids but not tocilizumab. Disclosures All Authors: No reported disclosures

scholarly journals Characteristics and outcome of patients set up on high-flow oxygen therapy at home

2019 ◽  
Vol 13 ◽  
pp. 175346661987979 ◽  
Author(s):  
Samuel Dolidon ◽  
Johann Dupuis ◽  
Luis-Carlos Molano Valencia ◽  
Mathieu Salaün ◽  
Luc Thiberville ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Median Survival ◽  
Oxygen Therapy ◽  
Airway Disease ◽  
High Flow ◽  
University Hospital ◽  
Hypoxemic Respiratory Failure ◽  
High Flow Oxygen ◽  
At Home

Background: High-flow oxygen therapy (HFOT) is increasingly used for acute respiratory failure. Few data support its use at home for the treatment of chronic respiratory failure. Our aim was to report the pattern of the use of long-term HFOT in our center and the outcome of patients setup on long-term HFOT. Methods: A retrospective monocentric study including all patients setup on long-term HFOT between January 2011 and April 2018 in Rouen University Hospital was carried out. Patients were divided into two groups, patients with hypoxemic respiratory failure treated with nasal HFOT (nHFOT) and tracheotomized patients treated with tracheal HFOT (tHFOT). Results: A total of 71 patients were established on long-term HFOT. Out of these 43 (61%) were included in the nHFOT group and 28 (39%) were included in the tHFOT group. In the nHFOT group, underlying respiratory diseases were interstitial lung disease ( n = 15, 35%), pulmonary hypertension ( n = 12, 28%), lung cancer ( n = 9, 21%), and chronic airway disease ( n = 7, 16%). In the tHFOT group, the number of admissions for exacerbation decreased by −0.78 per year (–2 to 0) ( p = 0.045). In total, 51 (72%) patients were discharged to their homes and 20 (28%) went to a post-acute re-enablement facility. Median survival following HFOT was 7.5 months. Survival was significantly lower in the nHFOT group with a median survival of 3.6 months whereas median survival was not reached in the tHFOT group ( p < 0.001). Monthly costs associated with home delivery of HFOT were €476 (296–533) with significant differences in costs between the nHFOT group of €520 (408–628) and costs in the tHFOT group of €296 (261–475) ( p < 0.001). Conclusions: The use of long-term HFOT allows very severe patients to be discharged at a reasonable cost from acute care facilities. The reviews of this paper are available via the supplementary material section.

The Effect of High-Flow Nasal Oxygen Therapy on Postoperative Pulmonary Complications and Hospital Length of Stay in Postoperative Patients: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 35 (10) ◽  
pp. 1129-1140 ◽  
Author(s):  
Zhonghua Lu ◽  
Wei Chang ◽  
Shanshan Meng ◽  
Ming Xue ◽  
Jianfeng Xie ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Oxygen Therapy ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
High Flow ◽  
Hospital Length Of Stay ◽  
Cochrane Library ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
High Flow Oxygen

Objective: To evaluate the effect of high-flow nasal cannula oxygen (HFNO) therapy on hospital length of stay (LOS) and postoperative pulmonary complications (PPCs) in adult postoperative patients. Data Sources: PubMed, Embase, the Cochrane Library, Web of Science of Studies, China National Knowledge Index, and Wan Fang databases were searched until July 2018. Study Selection: Randomized controlled trials (RCTs) comparing HFNO with conventional oxygen therapy or noninvasive mechanical ventilation in adult postoperative patients were included. The primary outcomes were hospital LOS and PPCs; short-term mortality (defined as intensive care unit, hospital, or 28-day mortality) and intubation rate were the secondary outcomes. Data Extraction: Demographic variables, high-flow oxygen therapy application, effects, and side effects were retrieved. Data were analyzed by the methods recommended by the Cochrane Collaboration. The strength of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation. Random errors were evaluated with trial sequential analysis. Data Synthesis: Fourteen studies (2568 patients) met the inclusion criteria and were included. Compared to the control group, the pooled effect showed that HFNO was significantly associated with a shorter hospital stay (mean difference: −0.81; 95% confidence interval [CI]: −1.34 to −0.29, P = .002), but not mortality (risk ratio [RR]: 1.0, 95% CI: 0.63 to 1.59, P = 1.0). Weak evidence of a reduction in reintubation rate (RR: 0.76, 95% CI: 0.57-1.01, P = .06) and PPC rate (RR: 0.89, 95% CI: 0.75-1.06, P = .18) with HFNO versus control group was recorded. Conclusions: The available RCTs suggest that, among the adult postoperative patients, HFNO therapy compared to the control group significantly reduces hospital LOS.

scholarly journals 1015 Elective Cancer Surgery In COVID-19 Free Surgical Pathways During The SARS-Cov-2 Pandemic: An International, Multi-Centre, Comparative Cohort Study

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Keyword(s):  
Cohort Study ◽  
Pulmonary Complication ◽  
Elective Surgery ◽  
Pulmonary Complications ◽  
Cancer Surgery ◽  
Sensitivity Analyses ◽  
Solid Cancer ◽  
Postoperative Pulmonary Complication ◽  
Complication Rates ◽  
Inpatient Ward

Abstract Introduction This study aimed to determine whether COVID-19 free surgical pathways were associated with lower postoperative pulmonary complication rates compared to hospitals with no defined pathway. Method This international multi-centre cohort study included patients undergoing elective surgery for 10 solid cancer types, without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until 19 April 2020. At the time of surgery, hospitals were defined as having a COVID-19 free surgical pathway (complete segregation of the operating theatre, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with COVID-19 patients). The primary outcome was 30-day postoperative pulmonary complications. Results Of 9171 patients from 447 hospitals in 55 countries, 2481 were operated in COVID-19 free surgical pathways. After adjustment, pulmonary complication rates were lower with COVID-19 free surgical pathways (2.2% versus 4.9%, OR: 0.62 [0.44-0.86]). This was consistent in sensitivity analyses and a propensity-score matched model. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19 free surgical pathways (2.1% versus 3.6%; OR 0.53 [0.36-0.76]). Conclusions Within available resources, dedicated COVID-19 free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.

High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

2020 ◽  
Vol 5 (4) ◽  
pp. 1006-1010
Author(s):  
Jennifer Raminick ◽  
Hema Desai
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Oxygen Therapy ◽  
Respiratory Illness ◽  
High Flow ◽  
Oral Feeding ◽  
Respiratory Support ◽  
Acute Respiratory Illness ◽  
High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

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