Comparison of Post-Extubation Pulmonary Outcomes Between High Flow Nasal Cannula and Conventional Oxygen Therapy in Elderly Cardiac Surgery Patients

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Abstract
Background: High-flow nasal cannula (HFNC) therapy is increasingly utilized following extubation in patients undergoing cardiac surgery, due to its potential benefits in preventing pulmonary complications such as atelectasis, pleural effusion, and pneumonia. However, the comparative efficacy of HFNC versus conventional oxygen therapy (COT) in elderly patients remains unclear. This study aims to compare post-extubation pulmonary outcomes between HFNC and COT in elderly patients following cardiac surgery. Methods: We conducted a retrospective cohort study at a tertiary care hospital in Southern Thailand, including patients aged 65 and older who underwent elective cardiac surgery between December 2018 and January 2024. The primary outcome was the incidence of post-extubation pulmonary complications (PPCs) within 72 hours. Secondary outcomes included the length of intensive care unit (ICU) and hospital stays, all-cause in-hospital mortality, and atelectasis scores. Results: A total of 424 patients were included, with 212 patients in each group. HFNC therapy was associated with a significant reduction in the odds of bronchospasm (7.5% vs. 24.5%; adjusted OR = 0.22, 95% CI = 0.12–0.41). There were no significant differences between the groups in terms of reintubation rates, tracheostomy, ICU stay, hospital stay, or all-cause mortality. However, atelectasis scores were significantly improved on day 5 post-extubation. Conclusion: HFNC therapy may reduce the incidence of bronchospasms in elderly patients after cardiac surgery and significant improvement of atelectasis score at day 5. While these findings suggest a potential benefit of HFNC in postoperative care, further research is warranted to explore its long-term effects and implications for patient outcomes.

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