Introduction: More centers are adopting fast track protocols to minimize recovery times and hospital stays after cardiac surgery. Patient selection centers around identifying low risk, elective candidates who can be extubated within 6 hours. Concomitantly, high flow nasal canula (HFNC) is gaining popularity to reduce re-intubation rates. However, there is a paucity of data comparing HNFC with conventional oxygen therapy (COT) in fast track patients. We examined the impact of extubation to HFNC vs. COT in patients undergoing elective coronary artery bypass graft (CABG) surgery regarding length of stay and patient outcomes. Methods: This is an IRB approved retrospective cohort study focused on patients undergoing elective isolated CABG in a three-year time frame. The primary independent variable for analysis was oxygen modality post-extubation (HNFC or COT), and the primary outcomes assessed were ICU and hospital length of stay (LOS), and extubation failure. 3 outliers (1 HFNC and 2 COT) were removed from the final statistical analysis. Results: The study included 231 patients with a median age of 65 (IQR 59-72) comprising 191 (83%) males and 40 (17%) females. A total of 151 (65%) patients were extubated to COT, 80 (35%) to HFNC, and 80% of each group met fast-track criteria. The groups were similar in demographics, comorbidities, and peri-operative metrics (vital signs, blood gas values, and vasopressor requirements). There was a statistically significant increase in both ICU LOS (+0.658 days, p=0.003) and hospital LOS (+0.438 days, p=0.04) in patients extubated to HFNC vs. COT, and this trend was also significant in the fast track population. Notably, the additional ICU LOS seen in the HFNC cohort is over 25% of the median ICU LOS for the study population overall. No patients were reintubated and 18 COT patients (12%) required escalation to HFNC but still had no significant increase in ICU or hospital LOS. Ultimately, the HFNC cohort experienced an estimated additional 52 days of ICU LOS and 35 days of hospital LOS which would have been avoided with extubation to COT. Conclusions: In our cohort, extubation to COT was safe and associated with shorter ICU and hospital LOS. While HFNC is an important resource at our disposal, its application needs to be better defined in fast track cardiac surgery patients.
Reichard et al. (Sun,) studied this question.