High-flow nasal oxygen therapy in patients after esophageal interventions: аdvantages and disadvantages

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Abstract

BACKGROUND: Pulmonary complications in patients who underwent esophagectomy with one-stage esophagoplasty are a frequent cause of death in the intensive care unit (ICU). However, the use of noninvasive ventilation (NIV) in these patients is not indicated because of the failure of esophagogastric anastomosis. Compared with NIV and standard oxygen therapy, high-flow oxygen therapy (HFOT) reduces the rate of transfer to mechanical ventilation (MV) in the case of acute respiratory failure.

AIM: This study aimed to assess the clinical advantages and disadvantages of HFOT in patients with respiratory failure after esophagectomy.

MATERIALS AND METHODS: Ninety patients with esophagectomy were examined. Two groups were formed by randomization: group 1 (n=45) with standard respiratory therapy, incentive spirometry, and nasal oxygen therapy with NIV sessions and low end-expiratory pressure (up to 6 mmHg) and group 2 (n=45) with HFOT. Therapy parameters were selected according to oxygenation (PaO2/FiО2) and saturation (SaО2) index values. Parameter changes, session duration, patient’s tolerance to respiratory therapy methods (from 1 to 10 points), dynamics of chest X-ray pattern, and duration of treatment in ICU were analyzed.

RESULTS: The advantages of HFOT were the absence of discomfort during the session, possibility to decrease O2 flow required for an adequate level of oxygenation, high flow with controlled O2 fraction allowed to reach target values of oxygenation index, decreased frequency of patients transfer to MV, and time spent in ICU.

CONCLUSIONS: The use of HFOT is justified as part of the complex respiratory therapy in patients with moderate respiratory failure. In patients with severe respiratory failure, HFOT is an alternative to other high-flow techniques and NIV. The choice between these methods should be individualized and depend on the patient’s condition and ventilation requirement.

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About the authors

Anton V. Geyze

A.V. Vishnevski National Medical Research Center of Surgery

Email: antongeyze@mail.ru
ORCID iD: 0000-0002-7145-8516

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Iuliia V. Koroleva

National Medical Research Center «Treatment and Rehabilitation Center»

Author for correspondence.
Email: ykoroleva@med-rf.ru
ORCID iD: 0000-0002-9354-0828
Russian Federation, Moscow

Georgy P. Plotnikov

A.V. Vishnevski National Medical Research Center of Surgery

Email: georgpp@mail.ru
ORCID iD: 0000-0002-4291-3380

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Natalya B. Kovalerova

A.V. Vishnevski National Medical Research Center of Surgery

Email: kovalerova.nat@gmail.com
ORCID iD: 0000-0002-6951-1816

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Andrey A. Manevskiy

National Medical Research Center «Treatment and Rehabilitation Center»; Pirogov Russian National Research Medical University

Email: a_manevskiy@mail.ru
ORCID iD: 0000-0002-8776-1368

MD, Cand. Sci. (Med.), assistant

Russian Federation, Moscow; Moscow

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2. Fig. 1. Dynamics of saturation and oxygenation index values in a day in patients with posterior mediastinal gastroesophagoplasty and intrapleural anastomosis using standard respiratory therapy with low-pressure noninvasive ventilation and high-flow nasal oxygen therapy.Note: * р <0.05. X axis, observation hours; Y axis, oxygenation index (РаO2/FiO2ratio); СРТ, standard respiratory therapy with sessions of noninvasive ventilation; ВПО, high-flow nasal oxygen therapy.

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