Hypoxemia
Conditions
Keywords
hypoxemia, high-flow, atrial fibrillation, sleep
Brief summary
The investigators hypothesized that heated humidified high-flow nasal cannula oxygen(HFNC) along with high quality of sleep, in comparison with noninvasive positive pressure ventilation (NIV), could reduce the release of inflammatory marker C-reactive protein(CRP), which as independent predictor of atrial fibrillation（AF）, further lower the incidence of new-onset AF following coronary artery bypass grafting(CABG).
Detailed description
Atrial fibrillation (AF) has been reported to occur in up to 20-40% of patients undergoing coronary artery bypass grafting (CABG). Postoperative AF plays a major role in the determination of hemodynamic deterioration and can be associated with thromboembolic stroke. Aside from the risk factors of age, pain, cardiac dysfunction and hypokalemia, hypoxemia is also considered to be the major contributor to AF initiation and persistence. Aiming to the common postoperative complications, noninvasive positive pressure ventilation (NIV) provides an available modality to improve the oxygen and even obviate the reintubation. However, some patients are contraindications for NIV, with Loss of consciousness, hemodynamic instability, and some are intolerance due to dryness, gastric distension, skin breakdown and noise, with complaints of insomnia and sleep disturbance. The aforementioned factors largely limits its use. Recently, the heated humidified high-flow nasal cannula (HFNC), free of psychic stress and physical discomfort, shows a favorable compliance and tolerance in treating the hypoxemic patients. As a result, in this comfortable setting we predict a high sleep quality in HFNC oxygen therapy. Evidence has suggested that sleep abnormalities trigger the cascaded release of C-reactive protein (CRP). As is well known that CRP is involved in atrial structural remodeling and asynchronous conduction, which attribute to the initiation and maintenance of AF. Therefore, in this present study, the investigators first evaluate the sleep quality (architecture and duration) by the polysomnographic (PSG) monitoring after coronary surgery. Based on the sleep parameters, the investigators hypothesize that HFNC, along with high quality of sleep, in comparison with NIV, could reduce the release of C-reactive protein, which as independent predictor of atrial fibrillation (AF), further lower the incidence of new-onset AF following CABG.
Interventions
HFNC device (Airvo™, Fisher＆Paykel, Auckland, New Zealand) with a heated circuit (Fisher＆Paykel,900PT501) and nasal cannula(optiflow TM,Fisher＆Paykel). It has adjustable FiO2: 21%-100%, gas flow up to 60 L/min, to maintain arterial blood hemoglobin oxygen saturation ( SPO2) \> 92%.
DEVICEnoninvasive ventilation
TBird VELA ventilator, CareFusion, USA. Pressure adjustments were to optimize patient comfort. Inspiratory pressure was raised every 5 mins until comfort was optimized. FiO2 was adjusted to maintain SPO2 \> 92%.
Sponsors
Henan Institute of Cardiovascular Epidemiology
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Hypoxemic respiratory failure
Exclusion criteria
Cardiac or respiratory arrest
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of atrial fibrillation | 10 days | from ICU admission to discharge |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Lactate levels | 5 days | from ICU admission to discharge |
| intubation time | 5 days | from intubation in the operating room to discharge |
| transfusion requirement | 5 days | from ICU admission to discharge |
| PO2/FiO2(P/F) | 5 days | from ICU admission to discharge |
| total sleep time | 48 hours | The duration from 8 in the evening to 8 in the morning within the first 2 days after surgery. |
| rapid eye movement (REM) sleep (%) | 48 hours | The duration from 8 in the evening to 8 in the morning within the first 2 days after surgery. |
| arousal index | 48 hours | The duration from 8 in the evening to 8 in the morning within the first 2 days after surgery. |
| inotropic usage | 5 days | from ICU admission to discharge |
Countries
China
Contacts
Primary ContactYou Zhang, MD
Outcome results
None listed