Effect of high-flow nasal cannula therapy on post-extubation hemodynamics after the Fontan procedure: A retrospective study

Abstract

Purpose: High-flow nasal cannula oxygen therapy (HFNC) in children undergoing Fontan surgery may reduce intrathoracic pressure and improve hemodynamics by improving oxygenation and thoraco-abdominal synchrony and reducing atelectasis. We aimed to determine the effect of HFNC on post-Fontan procedure hemodynamics. Methods: Patients who underwent Fontan surgery between November 1, 2014 and December 31, 2020 were enrolled. The change in central venous pressure (CVP) after surgery; both CVP and mean arterial pressure (ABP) 1, 2, 4, 6, 12, and 24 h post-extubation; partial pressures of arterial oxygen (PaO₂) and carbon dioxide (PaCO₂) 1 h after extubation; urine output and chest drainage and infusion volumes 6 h after extubation; vasoactive inotropic score (VIS); and other outcomes were compared between patients receiving conventional oxygen therapy (COT; C group) and those receiving HFNC (H group). After adjusting for confounding factors, the CVP 1 h pre- and post-extubation were compared between the groups. Results: Of the 199 included patients, 61 in each group were analyzed after propensity score matching. There were no significant between-group differences in the change in CVP from 1 h pre-extubation to 1 h post-extubation (COT: 2.9 ± 2.2 mmHg vs. HFNC: 2.5 ± 1.9 mmHg, p＝0.66), PaCO₂, mean ABP, use of vasoactive or inotropic drugs, the level of aspartate aminotransferase or alanine aminotransferase, reintubation rate, or postoperative length of intensive care unit stay. The H group had a significantly higher PaO₂ 1 h post-extubation (241 mmHg vs. 183 mmHg, p＝0.02). Conclusion: HFNC does not significantly improve hemodynamics after the Fontan procedure.