Complex effects of high-flow nasal cannula therapy on hemodynamics in the pediatric patient after cardiac surgery

Objectives: Infants and children with congenital heart disease may develop respiratory failure in association with cardiac surgery or as a result of heart disease. In fact, the postextubation period in this group of patients can be complex and the use of continuous positive airway pressure or non-invasive ventilation may be necessary if conventional oxygen therapy is not sufficient. The aim of our study was to compare efficiency and outcomes of high-flow nasal cannula or conventional oxygen therapy post-extubation after pediatric cardiac surgery . Patients and Methods: A single centre retrospective study was conducted between January and december 2020 in our 12 beds pediatric cardiac intensive care unit. Patients were divided into two groups. In one group 45 patients (Group I), those who received high-flow nasal cannula after extubation, and in the other group 45 patients (Group II), those who received oxygen therapy with a mask after extubation. The aim of the study was to evaluate the relative efficacy of high flow nasal cannula and conventional oxygen therapy on PaCO2 ,PaO2 and PaO2/FiO2. Results: PaO2 values at 1, 6, 12, 24 and 48 h post-extubation were significantly higher in high-flow nasal cannula group (p<0,05). PaCO2 values were significantly lower in the high-flow nasal cannula group at 1, 6, 12, 24 and 48 h post-extubation (p=0,01). PaO2/FiO2 values in high-flow nasal cannula group at all-time points post-extubation were significantly higher than in conventional oxygen therapy group (p=0,01). Conclusion: High-flow nasal cannula is useful in decreasing PaCO2 and improving PaO2 in children following extubation after cardiac surgery. In addition, the simplicity of and tolerability to high-flow nasal cannula is also important. Although more expensive, the use of high-flow nasal cannula can be considered as a safe and effective alternative to conventional oxygen therapy following pediatric cardiac surgery.

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Physiological impact of high-flow nasal cannula therapy on postextubation acute respiratory failure after pediatric cardiac surgery: a prospective observational study

Journal of Intensive Care ◽

10.1186/s40560-017-0226-z ◽

2017 ◽

Vol 5 (1) ◽

Cited By ~ 8

Author(s):

Naohiro Shioji ◽

Tatsuo Iwasaki ◽

Tomoyuki Kanazawa ◽

Kazuyoshi Shimizu ◽

Tomohiko Suemori ◽

...

Keyword(s):

Cardiac Surgery ◽

Respiratory Failure ◽

Observational Study ◽

Acute Respiratory Failure ◽

Prospective Observational Study ◽

High Flow ◽

Nasal Cannula ◽

Pediatric Cardiac Surgery ◽

High Flow Nasal Cannula ◽

Physiological Impact

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Effect of High-Flow Nasal Cannula on Thoraco-Abdominal Synchrony in Pediatric Subjects After Cardiac Surgery

Respiratory Care ◽

10.4187/respcare.06193 ◽

2018 ◽

Vol 64 (1) ◽

pp. 10-16

Author(s):

Taiga Itagaki ◽

Nobuto Nakanishi ◽

Nao Okuda ◽

Emiko Nakataki ◽

Mutsuo Onodera ◽

...

Keyword(s):

Cardiac Surgery ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula

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A novel method during ventilator weaning; decreasing pulmonary vascular resistance of the children performed cardiac surgery: high flow nasal cannula-nitric oxide combination therapy

Journal of the Japanese Society of Intensive Care Medicine ◽

10.3918/jsicm.24_407 ◽

2017 ◽

Vol 24 (4) ◽

pp. 407-411

Author(s):

Ryosuke Kowatari ◽

Yasuyuki Suzuki ◽

Kazuyuki Daitoku ◽

Ikuo Fukuda

Keyword(s):

Nitric Oxide ◽

Cardiac Surgery ◽

Combination Therapy ◽

Pulmonary Vascular Resistance ◽

Vascular Resistance ◽

Ventilator Weaning ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Novel Method

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Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1730933 ◽

2021 ◽

Author(s):

Hannah Stevens ◽

Julien Gallant ◽

Jennifer Foster ◽

David Horne ◽

Kristina Krmpotic

Keyword(s):

Cardiac Surgery ◽

Cohort Study ◽

Length Of Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Rescue Therapy ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Significant Difference

AbstractHigh-flow nasal cannula (HFNC) therapy is commonly used in the pediatric intensive care unit (PICU) for postextubation respiratory support. This hypothesis-generating retrospective cohort study aimed to compare postextubation PICU length of stay in infants extubated to HFNC and low flow oxygen (LF) in PICU following cardiac surgery. Of 136 infants (newborn to 1 year) who were intubated and mechanically ventilated in PICU following cardiac surgery, 72 (53%) were extubated to HFNC and 64 (47%) to LF. Compared with patients extubated to LF, those extubated to HFNC had significantly longer durations of cardiopulmonary bypass (152 vs. 109 minutes; p = 0.002), aortic cross-clamp (90 vs. 63 minutes; p = 0.003), and invasive mechanical ventilation (3.2 vs. 1.6 days; p < 0.001), though demographic and preoperative clinical variables were similar. No significant difference was observed in postextubation PICU length of stay between HFNC and LF groups in unadjusted analysis (3.3 vs. 2.6 days, respectively; p = 0.19) and after controlling for potential confounding variables (F [1,125] = 0.17, p = 0.68, R2 = 0.16). Escalation of therapy was similar between HFNC and LF groups (8.3 vs. 14.1%; p = 0.41). HFNC was effective as rescue therapy for six patients in the LF group requiring escalation of therapy. Need for reintubation was similar between HFNC and LF groups (8.3 vs. 4.7%; p = 0.5). Although extubation to HFNC was associated with a trend toward longer postextubation PICU length of stay and was successfully used as rescue therapy for several infants extubated to LF, our results must be interpreted with caution given the limitations of our study.

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