Comparing High-Flow Nasal Cannula Therapy and Conventional Oxygen Therapy in Adult Patients Post-Cardiac Surgery: A Systematic Review and Meta-Analysis.

Khan MM, Bacha Z, Khan FA, +13 more, Kumar B

ReviewAbstract only — full text under license

AI summary — for doctors, generated from the abstract only

After cardiac surgery, high-flow nasal cannula reduced the need to escalate respiratory support and improved oxygenation compared with conventional oxygen, but did not change mortality and increased delirium.

What was studied

Systematic review and random-effects meta-analysis of randomized trials (PubMed, Embase, Scopus to May 2026) comparing HFNC with conventional oxygen after cardiac surgery.

Key findings

11 RCTs with 2473 patients were included.
HFNC reduced escalation of respiratory support (RR 0.71, 95% CI 0.55-0.93).
Delirium was higher with HFNC (RR 3.63, 95% CI 1.80-7.30), with no differences in intubation, mortality, hospital stay, ICU stay, or postoperative atrial fibrillation.

Clinical relevance

HFNC may have physiologic advantages, but the delirium signal and lack of hard outcome benefit should temper routine use.

Who should care

Anaesthesiology

Limitations

Trial-level heterogeneity and risk of bias are not reported in the abstract, and the delirium finding may reflect differences in assessment. Escalation of support is a soft outcome.

HFNC improves oxygenation but did not improve mortality or reintubation and was associated with more delirium.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

BACKGROUND

Cardiac surgery with cardiopulmonary bypass structurally alters respiratory mechanics and carries a substantial risk of postoperative morbidity. Historically, patients have routinely received conventional oxygen therapy (COT) following extubation. High- flow nasal cannula (HCNC) therapy has emerged as an innovative respiratory support system. By synthesizing all currently available high-quality randomized controlled trials (RCTs), this study aimed to rigorously evaluate the efficacy and safety of HFNC compared to COT, focusing primarily on determining the need for escalation of respiratory support.

METHODOLOGY

A thorough electronic search was carried out in the PubMed, Embase, and Scopus databases from their inception to May 2026. Only RCTs were considered for analysis. A random-effects model was applied to compute pooled estimates and 95% confidence intervals (CIs).

RESULTS

A total of 11 RCTs, comprising 2473 patients, were included in this systematic review and meta-analysis. HFNC had a statistically significant effect on reducing the requirement for escalation of respiratory support (risk ratio [RR] = 0.71; 95% CI, 0.55-0.93; p = 0.01). HFNC had a statistically significant effect on improving the arterial partial pressure of oxygen, as well as forced expiratory volume in 1 second, while also increasing delirium complications (RR = 3.63; 95% CI, 1.80-7.30; p = 0.0003). There were no statistically significant differences between the 2 approaches in the other secondary clinical and resource utilization outcomes, including intubation, overall mortality, hospital length of stay, intensive care unit length of stay, and postoperative atrial fibrillation.

CONCLUSION

In adult patients recovering from cardiac surgery, HFNC therapy improves oxygenation and significantly curtails the need to escalate respiratory support compared to COT. However, these physiologic and intermediate clinical benefits do not translate into reductions in mortality, reintubation rate, or hospital length of stay and may come at the cost of increased postoperative delirium.

DOI

10.1053/j.jvca.2026.09.009

PMID

42881055

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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