High-flow nasal cannula oxygen therapy in patients undergoing thoracic surgery: current evidence and practice.

PURPOSE OF REVIEW: Patients undergoing thoracic surgery are at high risk for pulmonary and extra pulmonary complications, and may develop impairment of gas exchange during surgery and in the postoperative period. This review focuses on the potential benefits of high-flow nasal cannula (HFNC) oxygen therapy in those patients.

RECENT FINDINGS: HFNC oxygen therapy can be used pre, intra and postoperatively. However, evidence for the use of HFNC oxygen therapy is still limited. Most trials investigated the effects of HFNC oxygen therapy in the postoperative period only, with promising beneficial effects. Preoperative HFNC oxygen therapy might be an alternative to conventional techniques, and allows continuous oxygenation during the apneic time of laryngoscopy. In certain patients, thoracic surgery might be performed in awake and nonintubated patients who are breathing spontaneously. Under these conditions, HFNC oxygen therapy might be considered for respiratory support by experienced anesthesiologists. In the postoperative period, HFNC oxygen therapy can prevent escalation of respiratory management and has the potential to reduce the length of hospital stay. Throughout the perioperative period, close monitoring of patients receiving HFNC oxygen therapy is key, and intubation criteria to avoid delayed intubation should be defined a priori to prevent harm.

SUMMARY: HFNC oxygen therapy is a promising tool in the perioperative care of thoracic surgical patients, when properly set, performed by experienced staff and closely monitored.