High-Flow Nasal Oxygen Therapy After Cardiac Surgery
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Importance: High-flow nasal oxygen therapy (HFNOT) is used for noninvasive respiratory support following cardiac surgery despite uncertainty about its clinical effectiveness or associated costs. Objective: To determine whether prophylactic HFNOT in patients at increased risk of respiratory complications following cardiac surgery has clinical benefits compared with standard oxygen therapy (SOT). Design, Setting, and Participants: This adaptive, parallel group, randomized clinical trial collected and analyzed data from 17 cardiac surgery centers in 3 countries between October 7, 2020, and June 19, 2024. Eligible participants included adults undergoing nonemergent cardiac surgery with any of the following risk factors for pulmonary complications: chronic obstructive pulmonary disease, asthma, lower respiratory tract infection in the last 4 weeks, a body mass index of 35 or greater, or currently or recently smoking for longer than 10 pack-years. Outcome assessors were blinded. A preplanned sample size re-estimation was conducted after 300 participants completed the 90-day follow-up. Intervention: Participants were randomized at a 1:1 ratio with concealed allocation to HFNOT or SOT administered for at least 16 hours immediately after postoperative extubation. Main Outcomes and Measures: The primary effectiveness outcome was days alive and at home (DAH) without increased support compared with baseline in the first 90 days (DAH90). Any day of increased support, including at home, would provide a value of 0 for that day. Secondary outcomes included DAH90 without considering the additional support component. Results: A total of 1280 patients were recruited (mean [SD] age, 62.9 [10.5] years; 892 [69.7%] men; 640 in each group), of whom 1224 (95.6%) had complete DAH90 data. The primary outcome of median DAH90 was 0 (IQR, 0-79) for the HFNOT group and 0 (IQR, 0-87) for the SOT group (median difference, 0 [95% CI, 0-0]; P = .75). Secondary clinical outcomes, including DAH90 without considering whether additional support was required, were similar between groups. Conclusions and Relevance: In this randomized clinical trial of HFNOT in patients at increased risk of postoperative pulmonary complications after nonemergent cardiac surgery, HFNOT did not improve DAH90 without increased support. These findings do not support the implementation of routine prophylactic HFNOT after cardiac surgery. Trial Registration: isrctn.org Identifier: ISRCTN14092678.
Source: JAMA Network Open
Authors: Edward Litton, Rachael L. Parke, Shay P. McGuinness, Sarah N. Dawson, Sofia S. Villar, Siddesh S. Shetty, Julia A. Fox-Rushby, Julieann Coombes, Richard Norman, Gavin J. Murphy, Jacquita S. Affandi, Aamer B. Ahmed, Fiona E. Bottrill, Yi-Da Chiu, Luke J. Churchill, Sananta K. Dash, Anthony P. Delaney, Melissa J. P. Duckworth, Melissa J. Earwaker, Caroline R. Evans, Andrew J. Hoppington, Gudrun Kunst, Andrew J. Maiorana, Guillermo Martinez, Andrew McDonald, Ayman A. Mohammed, Neil R. Orford, David V. Pilcher, Mahesh Ramanan, Christopher M. Reid, Sivagnanavel Senthuran, Michael W. Shaw, Benjamin G. Shelley, Harjot Singh, C. Jo M. Steele, Ellen B. Temple, Marijcke W. M. Veltman-Grisenthwaite, Sumit Yadav, Nicoletta Zimbler, Vasileios Zochios, Andrew A. Klein, Nasal High-Flow Oxygen Therapy After Cardiac Surgery Investigators, Leena Chaudhari, Hakeem Yusuff Yusuff, Mahfuji Ahmed, Faszai Chikwanha, Navneet Ghuhan, Beverly Hargadon, Alexander Parsons, Malvi Raval, Hardeep Aujla, Louise Hanson, Phillipa Sum, Jonathan Brand, Anthony Donnelly, Rachel Harrison, Rachel Kipling, Carmen Neave, Holly Patterson, Sue Metcalfe, Rachel Taylor, Laura Dymore-Brown, Daveena Meeks, Anna Broderick, Emma Clarey, Fatemah Karami, Harriet Noble, Kevin O'Reilly, Sian Saha, Caitlin Spooner, Kirsty Hedditch, Jasmine Palmer, Phillip Howells, Rebecca Boot, Sophia Beddows, Amy Clark, Caroline Dooley, Karen Ellis, Lisa Moody, Christopher Sheridan, Elaine Spruce, Sumayyah Ul-Rahman, Hazel Smith, Zohreh Farzad, Kevin Kirby, Elizabeth Mittoo, Annashyl West, Orla Worn, Susana Pina, Karen Fitzjohn, Elizabeth Hodge, Helen Holcombe, Jennifer Mackie, Georgia Moule, Jamie Pack, Carmen Pearn, Michelle Austin, Sarah Dennis, Katie Hodge, Khross Malgapo, Gayathri Namasivayah, Rosemary Thorton, Georgina Arnold, Rachel Kingstrom, Lucie Garner, Tariq Ali, Maeve Henry, Martin John, Kariem El-Boghdadly, Maame Aduse-Poku, Gary Colville, Gillian Radcliffe, Xioayu Zhang, Elisabeth Fell, Rachel Fraser, Cara Hughes, Philip McCall, Christine Aitken, Jocelyn Barr, Elizabeth Boyd, Julie Buckley, Patricia Griffen, Charlene Hamilton, Ruth McLaren, Lesley Truesdale, Kathryn Valdeavella, Joanna Ford, Catherine Sinclair, Michelle Keeley, Roisin Houston, Frederick Cripps, Tristan Hawkins, Joelle Healan, John Kirby, Kerry Paradowski, Nirav Patel, Yashangi Wagaarachige, Arwen Hutchings, Helen Paine, Mitel Patel, Kathryn Thomas, Frances Bass, Anne O'Connor, Elizabeth Yarad, Iris Baker-Pearson, Melanie White, Mettassa Zaro, Laura Adams, Thi Bao Chau, Grace Beaton, Jasmin Board, Emma Martin, Aimee Neylan, Sarah Robertshaw, Mayumi Ueoka, Sophia Wallace, Meredith Young, Simone Fitzgerald, Stacey Hawker, Joanne Boone, Alison Hodge, Karen French, Christine Robins, Nicholas Anthony, Colin Garlett, Alea McLean, Janet Ferrier, Farisha Ali, Katie Brooks, Magdalena Butler, Keri-Anne Cowdrey, Eileen Gilder, Alix Gray, Su-Zahn Koorts, Brittany Mason, Ellie McMahon, Karina O'Connor, Melissa Robertson, Laura Vui, Laura Weiss
Institutions: Curtin University, Fiona Stanley Hospital, University of Auckland, National Health Service, University of Cambridge, Royal Papworth Hospital, Papworth Hospital NHS Foundation Trust, MRC Biostatistics Unit, Medical Research Council, King's College London, The George Institute for Global Health, University of Leicester, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Prince Charles Hospital, Metro North Hospital and Health Service, Townsville Hospital, The University of Sydney, Royal North Shore Hospital, University Hospital of Wales, King's College Hospital NHS Foundation Trust, King's College Hospital, James Cook University Hospital, Deakin University, Geelong Hospital, The Alfred Hospital, Monash University, Guy's Hospital, St Thomas' Hospital, Golden Jubilee National Hospital, University of Glasgow, Queen Elizabeth Hospital Birmingham, Mater Misericordiae Hospital, Mater Private Hospital, Royal Brompton Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W7152012162