Randomized Controlled Trial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2022; 10(24): 8615-8624
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8615
High-flow nasal cannula oxygen therapy during anesthesia recovery for older orthopedic surgery patients: A prospective randomized controlled trial
Xiao-Na Li, Cheng-Cheng Zhou, Zi-Qiang Lin, Bin Jia, Xiang-Yu Li, Gao-Feng Zhao, Fei Ye
Xiao-Na Li, Cheng-Cheng Zhou, Zi-Qiang Lin, Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
Bin Jia, Xiang-Yu Li, Gao-Feng Zhao, Fei Ye, Department of Anaesthesiology, Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangzhou 510000, Guangdong Province, China
Author contributions: Li XN was the main contributor to this work; Li XN, Zhou CC, Jia B, Li XY, Zhao GF, and Ye F designed the research; Li XN and Ye F performed the research; Lin ZQ, Li XY contributed the new analytic tools; Li XN and Zhou CC analyzed the data; Li XN and Ye F wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee of the Ethics Committee of Guangdong Hospital of Conventional Chinese Medicine on January 29, 2021, No. YF2021-014-01.
Clinical trial registration statement: This study is registered at Clinical hospital center“Chinese Clinical Trial Registry”trial registry, No. ChiCTR2100044463.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at yepainclinic@163.com.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fei Ye, PhD, Doctor, Department of Anaesthesiology, Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), No. 111 Dade Road, Guangzhou 510000, Guangdong Province, China. yepainclinic@163.com
Received: April 11, 2022
Peer-review started: April 11, 2022
First decision: May 30, 2022
Revised: June 11, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: August 26, 2022
Abstract
BACKGROUND

Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications. Therefore, reducing the incidence of postoperative hypoxemia is a clinical concern.

AIM

To investigate the clinical efficacy of high-flow nasal cannula oxygen (HFNCO) in the resuscitation period of older orthopedic patients.

METHODS

In this prospective randomized controlled trial, 60 older patients who underwent orthopedic surgery under general anesthesia were randomly divided into two groups: those who used conventional face mask and those who used HFNCO. All patients were treated with 60% oxygen for 1 h after extubation. Patients in the conventional face mask group were treated with a combination of air (2 L) and oxygen (2 L) using a traditional mask, whereas those in the HFNCO group were treated with HFNCO at a constant temperature of 34 °C and flow rate of 40 L/min. We assessed the effectiveness of oxygen therapy by monitoring the patients’ arterial blood gas, peripheral oxygen saturation, and postoperative complications.

RESULTS

The characteristics of the patients were comparable between the groups. One hour after extubation, patients in HFNCO group had a significantly higher arterial partial pressure of oxygen (paO2) than that of patients in conventional face mask group (P < 0.001). At extubation and 1 h after extubation, patients in both groups showed a significantly higher arterial partial pressure of carbon dioxide (paCO2) than the baseline levels (P < 0.001). There were no differences in the saturation of peripheral oxygen, paO2, and paCO2 between the groups before anesthesia and before extubation (P > 0.05). There were statistically significant differences in paO2 between the two groups before anesthesia and 1 h after extubation and immediately after extubation and 1 h after extubation (P < 0.001). However, there were no significant differences in the oxygen tolerance score before leaving the room, airway humidification, and pulmonary complications 3 d after surgery between the two groups (P > 0.05).

CONCLUSION

HFNCO can improve oxygen partial pressure and respiratory function in elderly patients undergoing orthopedic surgery under general endotracheal anesthesia. Thus, HFNCO can be used to prevent postoperative hypoxemia.

Keywords: Anesthesia recovery, High flow nasal cannula oxygen, Hypoxemia, Older patients, Orthopedic surgery, Pulmonary complications

Core Tip: This prospective randomized controlled study involving 60 patients evaluated the effects of different oxygen delivery methods. Additionally, the study investigated the clinical efficacy of high-flow nasal cannula oxygen (HFNCO) on the recovery period of older orthopedic patients. The current results showed that HFNCO can improve oxygen partial pressure and respiratory function in older patients undergoing orthopedic surgery with general anesthesia under endotracheal intubation.