Comparison of High-Flow Nasal Cannula with Conventional Oxygen Therapy for Preventing Postoperative Hypoxemia in Patients with Lung Resection Surgery: A Meta-Analysis of Randomized Controlled Trials

Abstract Background: The efficacy of high-flow nasal cannula (HFNC) in patients extubated after lung resection surgery remains inconclusive. Our objective was to execute a meticulous systematic meta-analysis to accurately assess the advantages of HFNC for patients extubated after lung resection surgery, by examining postoperative hypoxemia and other patient-focused outcomes. Research question: For patients extubated after lung resection surgery, is HFNC an effective alternative to conventional oxygen therapy in reducing the risk of postoperative hypoxemia? Method: We searched PubMed, EMBASE, the Cochrane Library, and Web of Science to identify randomized controlled trials (RCT) from inception to July 2023. We employed the revised Cochrane Risk of Bias Tool(2.0) to evaluate the risk of bias of the included studies, and the GRADE method to ascertain the certainty of the pooled effect estimates. The primary outcome was the incidence of postoperative hypoxemia. Results: Five RCTs (n=564) were included in the ultimate analysis. Utilizing HFNC rather than COT did not reduce the risk of postoperative hypoxemia (relative risk (RR), 0.67; 95%CI, 0.30, 1.49;low certainty). Compared to COT, HFNC may significantly enhance oxygenation index within first 12 hours after extubation in patients with lung resection. There were no significant differences in reintubation rate(RR, 0.25; 95%CI, 0.04, 1.54; high certainty), escalation of respiratory support(RR, 0.35; 95%CI, 0.11, 1.08; high certainty), change in PaCO 2 within first 24 hours after extubation, hospital length of stay (mean difference (MD), −0.19; 95%CI, –0.44, 0.06; moderate certainty), and ICU length of stay (MD, 0.02; 95%CI, −0.16, 0.19;high certainty). Conclusions: Our meta-analysis revealed that, compared to COT, HFNC could significantly enhance the oxygen index within the first 12 hours in patients extubated after lung resection surgery, with no significant differences in other outcomes. To verify the effect of HFNC on this population, additional large-scale, multicenter studies are essential.