None listed
Conditions
Brief summary
Open heart surgery is being performed on increasing numbers of obese patients. Almost a third of patients undergoing open heart surgery are classified as obese. It is known that these patients are more prone to post operative complications, particularly lung collapse and that they recover more slowly from these complications. This increase in complications and slower recovery leads to longer intensive care unit and hospital stays. Our previous research has shown that high flow nasal prongs (HFNP) create positive airway pressure and that patients who are obese benefit even more from the positive effects of HFNP. Our study also showed that the patients' oxygen levels improved and their breathing felt more comfortable with the HFNP. Therefore, it is necessary that we further investigate the effects of HFNP on obese patients after cardiac surgery, in an attempt to reduce complications, particularly lung collapse.
Interventions
High flow nasal prongs, direct extubation post cardiac surgery
When the patient meets the extubation criteria of the unit, the patient will be extubated as per unit protocol. The patient will then receive treatment as per Protocol A (control) or B (treatment).
Protocol B (Treatment)
*Patient extubated directly onto HFNP which are humidified to 37 degrees prior to application
*Starting Flow rate set to 35 litres/min and titrated up to a maximum of 50 litres as determined by patient comfort
*Star
High flow nasal prongs, direct extubation post cardiac surgery When the patient meets the extubation criteria of the unit, the patient will be extubated as per unit protocol. The patient will then receive treatment as per Protocol A (control) or B (treatment). Protocol B (Treatment) *Patient extubated directly onto HFNP which are humidified to 37 degrees prior to application *Starting Flow rate set to 35 litres/min and titrated up to a maximum of 50 litres as determined by patient comfort *Starting FiO2 prescribed by Intensivist *Patient to remain on HFNP continuously for 8 hours – breaks allowed for nasal care or mobilization *Flow rate and FiO2 may be titrated to maintain SpO2 > 95% during the treatment period *HFNP will be removed at the end of the 8 hour period, or until no longer required as determined by the treating intensivist *Other treatments (i.e. Drug therapy, physiotherapy, upright positioning, and early mobilisation) will be conducted as per standard unit protocol in consultation with the treating intensivist and cardiac surgeon
Sponsors
Amanda Corley
Study design
Allocation
Randomised controlled trial
Primary purpose
Prevention
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Male or female >/= 18 years BMI >/= 30 Post on-cardiopulmonary bypass cardiac surgery
Exclusion criteria
Patient refusal Patients requiring direct extubation onto NIPPV Pneumothorax Patients unable to tolerate HFNP Those requiring tracheostomy Patients extubated as part of end of life treatment
Outcome results
None listed