早期高流量鼻氧对胸外科手术后膈功能和肺部并发症的影响：一项随机临床试验

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-07-23 DOI:10.1016/j.jclinane.2025.111945

Alberto Fogagnolo MD , Salvatore Grasso (Professor) , Martin Dres (Professor) , Danila Azzolina Professor, PhD , Francesca Dalla Corte MD , Giampiero Dolci MD , NIcola Tamburini MD , Giovanni De Paoli MD , Francesco Murgolo MD , Emma Pedarzani MA , Arianna Andalò MD , Carlo Alberto Volta Professor (Professor) , Spadaro Savino Associate Professor, PhD

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引用次数: 0

摘要

背景术后肺部并发症（PPCs）是胸外科手术后常见的并发症，尤其是术后膈功能障碍的患者。高流量鼻插管（HFNC）氧疗减少了术后呼吸功，提供了正呼气末压（PEEP）效应。因此，它可以减少胸外科手术后膈功能障碍和PPCs的发生。方法采用单中心、开放标签、随机对照试验。接受电视胸腔镜肺叶切除术的患者随机接受常规氧疗（COT）或高流量鼻插管氧疗。在两组中，吸入氧分数滴定达到外周血氧饱和度为94%。术后2、24 h测量膈位移（DD）和膈增厚分数（TF%）。膈功能障碍由DD <；10 mm确定。记录入组后7天内发生的PPCs。结果我们分析了116例患者。HFNC组术后膈功能障碍发生率为17/58 (29%)，COT组为21/58 (36%)（p = 0.55）。两组PPCs发生率相似：HFNC组为32/58 (55%)，COT组为37/58 (64%)（p = 0.449）。术后出现膈功能障碍的患者使用HFNC治疗后PPCs减少(20/37；54%)，而COT (17/21；81%) （p = 0.037）。一项事后混合模型分析证实HFNC降低了膈功能障碍患者PPCs的风险（OR 0.16, 95% CI 0.02-0.83）。结论早期HFNC支持并不能降低术后膈功能障碍率及呼吸并发症的发生率。对于术后出现膈功能障碍的患者，HFNC可能在减轻PPCs的风险中发挥作用。临床试验注册：NCT05532033

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Impact of early high flow nasal oxygen on diaphragmatic function and pulmonary complications after thoracic surgery: A randomized clinical trial

Background

Postoperative pulmonary complications (PPCs) are common after thoracic surgery, particularly in patients that develop postoperative diaphragmatic dysfunction. High-flow nasal cannula (HFNC) oxygen therapy decreases postoperative work of breathing and provides a positive end-expiratory pressure (PEEP) effect. As a result, it may decrease the occurrence of diaphragmatic dysfunction and PPCs after thoracic surgery.

Methods

Single-centre, open-label, randomized controlled trial. Patients undergoing video-assisted thoracoscopic lobectomy were randomized to receive conventional oxygen therapy (COT) or high flow nasal cannula oxygen therapy. In both groups, inspiratory oxygen fraction was titrated to reach a peripheral oxygen saturation of >94 %. Diaphragmatic displacement (DD) and diaphragmatic thickening fraction (TF%) were measured 2 and 24 h after surgery. Diaphragmatic dysfunction was identified by DD <10 mm. PPCs occurring within 7 days after study enrollment were recorded.

Results

We analyzed 116 patients in the study. Postoperative diaphragmatic dysfunction occurred in 17/58 patients (29 %) in the HFNC group compared to 21/58 (36 %) in the COT group (p = 0.55). The rate of PPCs was similar between the two groups: 32/58 (55 %) in the HFNC group and 37/58 (64 %) in the COT group (p = 0.449). Patients who developed postoperative diaphragmatic dysfunction experienced fewer PPCs when treated with HFNC (20/37; 54 %) compared to COT (17/21; 81 %) (p = 0.037). A post hoc mixed-model analysis confirmed that HFNC reduced the risk of PPCs in patients with diaphragmatic dysfunction (OR 0.16, 95 % CI 0.02–0.83).

Conclusions

Early HFNC support does not decrease the rate of postoperative diaphragmatic dysfunction rate or respiratory complications. In patients who develop postoperative diaphragmatic dysfunction, HFNC may play a role in mitigating the risk of PPCs.

Clinical trial registration: NCT05532033

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.