Nasal Oxygen Therapy After Cardiac Surgery (NOTACS)
Cardiac Valve Disease, Coronary Artery Disease, Respiratory Failure
About this trial
This is an interventional supportive care trial for Cardiac Valve Disease focused on measuring High-Flow Nasal Therapy, High-Flow Nasal Oxygen, Cardiac Surgery, Pulmonary Complications
Eligibility Criteria
Inclusion Criteria:
- Aged 18 years or over.
- Undergoing elective or urgent first-time or redo cardiac surgery (CABG, valve surgery or both)
- Have one or more clinical risk factors for postoperative pulmonary complications (COPD, asthma, lower respiratory tract infection in last 4 weeks as defined by use of antibiotics, body mass index ≥35 kg/m2 , current (within the last 6 weeks) heavy smoker (> 10 pack years)) (47, 48).
Asthma is a disease characterized by recurrent attacks of breathlessness and wheezing, and patients will have been prescribed medication by inhalers or nebulisers (either bronchodilators or steroids).
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe chronic lung diseases that cause limitations in lung airflow. The more familiar terms 'chronic bronchitis' and 'emphysema' are no longer used but are now included within the COPD 13 diagnosis. The most common symptoms of COPD are breathlessness, or a 'need for air', excessive sputum production, and a chronic cough. Patients suitable for the NOTACS study will have been prescribed medication by inhalers or nebulisers (either bronchodilators or steroids).
Exclusion Criteria:
- Requiring home oxygen therapy.
- Deep hypothermic circulatory arrest planned
- Contraindication to HFNT, e.g. nasal septal defect.
- Requirement for home ventilatory support (including: HFNT, CPAP, BiPAP)
- Requiring emergency cardiac surgery defined as surgery required within 24 hours of the decision to operate.
- Patients not fluent in English.
Sites / Locations
- Royal Papworth Hospital NHS Foundation TrustRecruiting
Arms of the Study
Arm 1
Arm 2
No Intervention
Other
Standard Oxygen Therapy
High-Flow Nasal Therapy
Standard oxygen therapy arm patients will be given 30-40% inspired O2 and flow 2-6 l/min via nasal prongs or non-rebreathing mask (not humidified and not heated) post extubation. Monitoring of saturations, respiratory rate and arterial gases will happen 15 minutes post extubation and then as per local policy thereafter. If saturations < 93% then FiO2 will be increased as per respiratory escalation protocol. Standard oxygen therapy will be given for a minimum of 16 hours post extubation.
High-flow nasal therapy arm patients will be given AIVRO 2 high flow oxygen therapy machines post extubation, start at 30-40% inspired O2 and flow 30 l/min then up to 50 l/min over 5-10 min. Monitoring of saturations, respiratory rate and arterial gases will happen after 15 minutes post extubation and then as per local policy thereafter. If saturations < 93% then increase FiO2 as per respiratory escalation protocol. High flow nasal therapy will be given for a minimum of 16 hours post extubation.