High-Flow Nasal Catheter (HFNC) Compared With Conventional Oxygenation

July 28, 2023 updated by: Desire Tarso Maioli, Federal University of Rio Grande do Sul

High-Flow Nasal Catheter (HFNC) Compared With Conventional Oxygenation During the Perioperative Period of Patients Undergoing Thoracic Surgery.

The purpose of this study, is to clarify whether there is benefit from the perioperative use of HFNC in thoracic surgeries, from intubation to the postoperative period, evaluating hipoxemia during orotracheal intubation, immediate complications after intubation, mortality and in-hospital complications.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

High-flow Nasal Catheter (HFNC) compared to oxygenation conventional during the perioperative period of patients undergoing thoracic surgery The increase in surgeries performed worldwide, with today an estimate of more than 300 million surgeries/year, makes us increasingly need knowledge and strategies to improve perioperative care. Complications in this period are responsible for an increase in morbidity and mortality of patients, reducing the effectiveness of the surgical treatment, mainly in developing countries. The use of a nasal cannula high-flow (HFNC) oxygen during the perioperative period offers a promising technique to improve the lung function of these patients, enabling better outcomes.

The purpose of this study, therefore, is to clarify whether there is benefit from the perioperative use of HFNC, in thoracic surgeries, from intubation to the postoperative period, evaluating mortality and in-hospital complications.

Primary and secondary objectives

Main goal

  • To evaluate the incidence of in-hospital pulmonary complications in 30 days in participants submitted to the use of HFNC in the perioperative period of participants undergoing thoracic surgery, when compared to the use of conventional oxygen therapy.
  • To evaluate in-hospital postoperative mortality within 30 days.

Secondary objectives

  • Assess the incidence of hypoxemia during orotracheal intubation and extubation
  • Assess the incidence of immediate complications after intubation and extubation (desaturation, failure of intubation/ extubation)

It will be a randomized, non-blinded, single-center clinical trial. Participants (older than 18 years old) who undergo thoracic surgery and who are at surgical risk for postoperative complications with ARISCAT > 26 (risk score for pulmonary complications) will be allocated consecutively and randomized to participate in the intervention group or control, receiving written informed consent to the study and interventions. The study will be carried out at Hospital Tacchini, from July 2023 to June 2024.

Control group will receive conventional oxygen therapy, and the intervention group will receive HFNC therapy at induction of anesthesia and postoperatively, after extubation.

Oxygenation will be performed, according to the randomization, in the control group, by mask facial, with 100% oxygen and flow of 10 L.min-1. The intervention group will receive oxygenby 100% HFNC with a flow of 40 L.min-1 being increased to 70 L.min-1 during the periodof apnea.

A rapid sequence of orotracheal intubation will be performed, considering the time of apnea the moment of disappearance of the capnography line until the first ventilation after tube placement. Difficulties and complications in carrying out this step will be described. A oxygen saturation will be measured before the start of pre-oxygenation and will be considered hypoxemia, any measurement below 90% saturation, during the initiation of the rapid sequence intubation up to 5 minutes after it, in both groups. All participants will be intubated according to current orotracheal intubation guidelines. After surgery, participants who are extubated in the operating room or in the intensive care unit, will remain in the control and intervention groups and will receive therapy for conventional oxygen or HFNC, respectively. The fraction of inspired oxygen (FiO2) will be titrated until pulse oximetry is above 95%, which is also reduced to the level minimum, to achieve this objective. In the control group, oxygen will be offered through a nasal catheter or face mask and those in the intervention group will receive oxygen through HFNC with flows adjusted between 30 and 50 L.min-1, depending on the respiratory rate (less than 16) and the patient comfort.

Data and statistics analysis strategy The data, after being collected, will be expressed as mean and standard deviation or absolute frequency and relative. Data normality will be tested by the Kolmogorov-Smirnov test. The difference Significant difference between groups will be analyzed using Student's t test for data for parametric data and for non-parametric data the Wilcoxon test will be used. The program used will be the Statistical Package for the Social Sciences, version 20 (SPSS Inc., Chicago, IL,USA) and the significance level adopted will be p<0.05.

Calculation and/or justification of the sample size According to the literature, patients undergoing thoracic surgery may present severe complications such as postoperative hypoxemia in up to 30% of cases, after extubation. Based on the literature review, the sample calculation should be 45 patients for each group. For the sample calculation, we considered the value of β of 20% and α of 5%.

. Using a effect size (calculated from the article data) of 0.6, a statistical power of 80% and a significance level of p<0.05 (or 5%), the investigators obtained as a result the n of 90 volunteers per group (final sample, excluding possible losses). The G*Power program version 3.1.9.2 for Windows (Franz Faul, University Kiel, Germany) was used to perform the calculation.

Study Type

Interventional

Enrollment (Estimated)

90

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Brazil
    • Rio Grande Do Sul
      • Bento Gonçalves, Rio Grande Do Sul, Brazil, 95700348
        • Recruiting
        • Desejo Tarso Maioli
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • All patients over 18 years of age who will undergo elective thoracic surgery and who have an ARISCAT score > 26.

Exclusion Criteria:

  • Patients who need urgent/emergency surgery, pregnant women, who do not have an ARISCAT score > 26 and those who refuse to participate in the study.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Single Group Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: HFNC
The intervention group will receive HFNC therapy at induction of anesthesia. The intervention group will receive oxygen by 100% HFNC with a flow of 40 L.min-1 being increased to 70 L.min-1 during the period of apnea. A rapid sequence of orotracheal intubation will be performed, considering the time of apnea the moment of disappearance of the capnography line until the first ventilation after tube placement.
Device: high flow nasal cannula

The purpose of this intervention is clarify the benefit with the perioperative use of HFNC, in thoracic surgeries, from intubation to the postoperative period, evaluating mortality and in-hospital complications.

is to clarify whether there is benefit from the perioperative use of HFNC, in thoracic surgeries, from intubation to the postoperative period, evaluating mortality and in-hospital complications.
No Intervention: Convencional oxygen therapy
Control group will receive conventional oxygen therapy by mask facial, with 100% oxygen and flow of 10 L.min-1.After surgery, patients who are extubated in the operating room or in theintensive care unit, will remain in the control and intervention groups and will receive therapy for conventional oxygen or HFNC, respectively.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pulmonary Complications
Time Frame: 30 days
To evaluate the incidence of in-hospital pulmonary complications in 30 days in patients submitted to the use of HFNC in the perioperative period of patients undergoing thoracic surgery, when compared to the use of conventional oxygen therapy. extubation
30 days
Mortality
Time Frame: 30 days
To evaluate in-hospital postoperative mortality within 30 days.
30 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of hipoxemia
Time Frame: 5 minuts
- Assess the incidence of hypoxemia during orotracheal intubation and extubation.
5 minuts
Complications after intubation and extubation
Time Frame: 5 minuts
Assess the incidence of immediate complications after intubation and extubation (desaturation, failure of intubation and extubation)
5 minuts

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Federal University of Rio Grande do Sul

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

July 28, 2023

Primary Completion (Estimated)

July 30, 2024

Study Completion (Estimated)

December 30, 2024

Study Registration Dates

First Submitted

May 29, 2023

First Submitted That Met QC Criteria

June 15, 2023

First Posted (Actual)

June 20, 2023

Study Record Updates

Last Update Posted (Actual)

August 1, 2023

Last Update Submitted That Met QC Criteria

July 28, 2023

Last Verified

July 1, 2023

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • U1111-1292-9259

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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