Randomized Controlled Trial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2022; 10(24): 8615-8624
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8615
High-flow nasal cannula oxygen therapy during anesthesia recovery for older orthopedic surgery patients: A prospective randomized controlled trial
Xiao-Na Li, Cheng-Cheng Zhou, Zi-Qiang Lin, Bin Jia, Xiang-Yu Li, Gao-Feng Zhao, Fei Ye
Xiao-Na Li, Cheng-Cheng Zhou, Zi-Qiang Lin, Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
Bin Jia, Xiang-Yu Li, Gao-Feng Zhao, Fei Ye, Department of Anaesthesiology, Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangzhou 510000, Guangdong Province, China
Author contributions: Li XN was the main contributor to this work; Li XN, Zhou CC, Jia B, Li XY, Zhao GF, and Ye F designed the research; Li XN and Ye F performed the research; Lin ZQ, Li XY contributed the new analytic tools; Li XN and Zhou CC analyzed the data; Li XN and Ye F wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee of the Ethics Committee of Guangdong Hospital of Conventional Chinese Medicine on January 29, 2021, No. YF2021-014-01.
Clinical trial registration statement: This study is registered at Clinical hospital center“Chinese Clinical Trial Registry”trial registry, No. ChiCTR2100044463.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at yepainclinic@163.com.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fei Ye, PhD, Doctor, Department of Anaesthesiology, Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), No. 111 Dade Road, Guangzhou 510000, Guangdong Province, China. yepainclinic@163.com
Received: April 11, 2022
Peer-review started: April 11, 2022
First decision: May 30, 2022
Revised: June 11, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: August 26, 2022
Processing time: 126 Days and 17.7 Hours
ARTICLE HIGHLIGHTS
Research background

In the future, we can extend the follow-up time, refine the evaluation indicators, further clarify the postoperative complications of elderly orthopedic surgery patients and use traditional Chinese medicine for intervention.

Research motivation

High-flow nasal cannula oxygen (HFNCO) can improve oxygen partial pressure and respiratory function in elderly patients undergoing orthopedic surgery under general endotracheal anesthesia. Thus, HFNCO can be used to prevent postoperative hypoxemia.

Research objectives

In comparison between the two groups, arterial partial pressure of oxygen (paO2) in HFNCO group was significantly better than that in the conventional group, while no significant differences were observed in other indicators. In intra-group comparison, paO2 had statistical differences at all time periods, pressure of carbon dioxide (paCO2) had statistically significant differences before and after extubation, and the other data showed no significant differences.

Research methods

In this prospective randomized controlled trial, 60 older patients who underwent orthopedic surgery under general anesthesia were randomly divided into two groups: those who used conventional face mask and those who used HFNCO. Blood gas analysis, including evaluation of the paO2, paCO2 and pH before induction of anesthesia, during extubation, and 1 h after extubation, was conducted for all older orthopedic patients. The patient information database was created and analysis using Excel and SPSS 18.0 software packages.

Research results

This randomized controlled trial aimed to report on the clinical efficacy of HFNCO and compare the effects of conventional mask oxygen and HFNCO on the recovery period of older (≥ 65 years) patients following orthopedic surgery.

Research conclusions

As HFNCO can be used to improve oxygenation and manage hypoxemia rapidly and efficiently, it can heat and humidify inhaled air. Furthermore, it is convenient and comfortable and has been gradually used in clinics in recent years.

Research perspectives

Hypoxemia may cause postoperative delirium and wound infection, and in severe cases, it may lead to multiple types of arrhythmia, nervous system injury, and abnormal changes in blood pressure. It can also increase the orthopedic perioperative risk in older patients, affect postoperative recovery, and even extend the length of hospital stay, and consequently, increase the economic burden. We hypothesized that HFNCO has an advantage over conventional mask oxygen in the resuscitation period of older orthopedic patients.