Prophylactic high-flow nasal oxygen vs. conventional oxygen for prevention of postoperative respiratory complications: a randomized trial.

BACKGROUND

Postoperative pulmonary complications (PPCs) are a major cause of morbidity after lung resection, particularly in older adults. Following extubation, noninvasive respiratory support strategies are increasingly used to prevent respiratory deterioration, but the role of prophylactic high-flow nasal cannula (HFNC) in this setting remains uncertain.

METHODS

In this single-center, open-label randomized controlled trial, patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy for stage I-IIIa non-small cell lung cancer (NSCLC) were randomized to HFNC or conventional oxygen therapy (COT). The primary outcome was PPC severity during hospitalization, analyzed using ordinal logistic regression; the incidence of clinically relevant PPCs (grade ≥ 2) was also compared between groups. Secondary outcomes included longitudinal respiratory symptoms (mMRC, LCQ-MC, sCSS) and symptom-related functional interference (MDASI-LC), analyzed using mixed-effects models.

RESULTS

A total of 210 patients were included in the modified intention-to-treat analysis (HFNC, n = 104; COT, n = 106). HFNC reduced PPC severity (ordinal OR, 0.50; 95% CI, 0.28-0.91; P = 0.022) and moderate-to-severe PPCs (23.1% vs. 39.6%; absolute risk difference, -15.6%; 95% CI, -28.0% to -3.2%; P = 0.010). HFNC was associated with a lower burden of clinically relevant PPCs. Secondary analyses also suggested improvements in early postoperative respiratory symptoms and symptom-related functional interference. Secondary analyses also suggested improvements in early postoperative respiratory symptoms and symptom-related functional interference. No differences were observed in physiological outcomes or length of stay.

CONCLUSION

In older adults undergoing lung resection, prophylactic HFNC reduced in-hospital PPC burden and was associated with more favorable early postoperative respiratory recovery. These findings suggest that prophylactic HFNC may provide benefit as a potential preventive respiratory support option in selected older or higher-risk postoperative patients, although routine prophylactic use in all patients undergoing lung resection is not supported by the present findings.

TRIAL REGISTRATION: This study was approved by the Chinese Clinical Trial Registry (ChiCTR2200063161) on 01 Sep 2022 and the first patient was enrolled after pre-registration.