Prophylactic high-flow nasal cannula oxygen therapy can reduce postoperative pulmonary complications in elderly patients with non-small cell lung cancer: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TU Xiuhua , LEI Mei , CHEN Yanqing , LIN Rongjia , HUANG Ruizhen ,  XIANG Chunmei

Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou, 350013, P. R. China;

Corresponding author：

XIANG Chunmei, Email: 1183203315@qq.com

Keywords：

High-flow nasal cannula oxygen therapy; non-small cell lung cancer; postoperative pulmonary complication; elderly patients

DOI：

10.7507/1007-4848.202211083

Video：

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Objective To investigate the clinical value of prophylactic high-flow nasal cannula oxygen therapy (HFNC) in reducing postoperative pulmonary complication (PPC) in elderly patients with non-small cell lung cancer (NSCLC). Methods The clinical data of elderly patients (over 60 years) with NSCLC who underwent video-assisted thoracoscopic lobectomy or segmental resection at the Department of Thoracic Surgery, Fujian Provincial Hospital from January 2021 to March 2022 were retrospectively analyzed. According to whether receiving HFNC after surgery, they were divided into a conventional oxygen therapy (CO) group and a HFNC group. The CO group were matched with the HFNC group by the propensity score matching method at a ratio of 1 : 1. We compared PPC incidence, white blood cell (WBC) count, procalcitonin and C-reactive protein on postoperative day (POD) 1, 3 and 5 and postoperative hospital stay between the two groups. Results A total of 343 patients (165 males, 178 females, average age of 67.25±4.79 years) were enrolled, with 53 (15.45%) receiving HFNC. Before matching, there were statistical differences in gender, rate of combined chronic obstructive pulmonary disease, pathology type and TNM stage between the two groups (all P<0.05). There were 42 patients successfully matched in each of the two groups, with no statistical difference in baseline characteristics (P>0.05). After propensity score matching, the results showed that the PPC incidence in the HFNC group was lower than that in the CO group (23.81% vs. 45.23%, P=0.039). WBC count on POD 3 and 5 and procalcitonin level on POD 3 were less or lower in the HFNC group than those in the CO group [ (8.92±2.91)×10⁹/L vs. (10.62±2.67)×10⁹/L; (7.68±1.58)×10⁹/L vs. (8.86±1.76)×10⁹/L; 0.26 (0.25, 0.44) μg/L vs. 0.31 (0.25, 0.86) μg/L; all P<0.05]. There was no statistical difference in the other inflammatory indexes or the postoperative hospital stay between the two groups (P>0.05). Conclusion Prophylactic HFNC can reduce the PPC incidence and postoperative inflammatory indexes in elderly patients with NSCLC, but does not shorten the postoperative hospital stay.

Citation： TU Xiuhua, LEI Mei, CHEN Yanqing, LIN Rongjia, HUANG Ruizhen, XIANG Chunmei. Prophylactic high-flow nasal cannula oxygen therapy can reduce postoperative pulmonary complications in elderly patients with non-small cell lung cancer: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(9): 1274-1280. doi: 10.7507/1007-4848.202211083 Copy

1.	Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016. J Nat Cancer Center, 2022, 2(1): 1-9.
2.	毛友生, 赫捷. 肺癌胸腔镜术后并发症的防治策略. 中国肺癌杂志, 2018, 21(3): 230-233.Mao YS, He J. The prevention and management strategy for postoperative complications after thoracoscopic surgery of lung cancer. Chin J Lung Cancer, 2018, 21(3): 230-233.
3.	Agostini PJ, Lugg ST, Adams K, et al. Risk factors and short-term outcomes of postoperative pulmonary complications after VATS lobectomy. J Cardiothorac Surg, 2018, 13(1): 28.
4.	Sabaté S, Mazo V, Canet J. Predicting postoperative pulmonary complications: Implications for outcomes and costs. Curr Opin Anaesthesiol, 2014, 27(2): 201-209.
5.	Kaufmann K, Heinrich S. Minimizing postoperative pulmonary complications in thoracic surgery patients. Curr Opin Anaesthesiol, 2021, 34(1): 13-19.
6.	Agostini P, Cieslik H, Rathinam S, et al. Postoperative pulmonary complications following thoracic surgery: Are there any modifiable risk factors? Thorax, 2010, 65(9): 815-818.
7.	Shi Q, Wang XS, Vaporciyan AA, et al. Patient-reported symptom interference as a measure of postsurgery functional recovery in lung cancer. J Pain Symptom Manage, 2016, 52(6): 822-831.
8.	Fagundes CP, Shi Q, Vaporciyan AA, et al. Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory. J Thorac Cardiovasc Surg, 2015, 150(3): 613-619.
9.	Ansari BM, Hogan MP, Collier TJ, et al. A randomized controlled trial of high-flow nasal oxygen (optiflow) as part of an enhanced recovery program after lung resection surgery. Ann Thorac Surg, 2016, 101(2): 459-464.
10.	中华医学会呼吸病学分会呼吸危重症医学学组, 中国医师协会呼吸医师分会危重症医学工作委员会. 成人经鼻高流量湿化氧疗临床规范应用专家共识. 中华结核和呼吸杂志, 2019, 42(2): 83-91.Respiratory & Critical Care Medicine Group of Chinese Thoracic Society, Respiratory & Critical Care Medicine Committee of Chinese Association of Chest Physician. Expert consensus of high-flow nasal cannula oxygen therapy on clinical application regularity. Chin J Tuberc Respir Dis, 2019, 42(2): 83-91.
11.	Pennisi MA, Bello G, Congedo MT, et al. Early nasal high-flow versus Venturi mask oxygen therapy after lung resection: A randomized trial. Crit Care, 2019, 23(1): 68.
12.	Detterbeck FC, Boffa DJ, Kim AW, et al. The eighth edition lung cancer stage classification. Chest, 2017, 151(1): 193-203.
13.	Travis WD, Brambilla E, Burke AP, et al. Introduction to the 2015 World Health Organization classification of tumors of the lung, pleura, thymus, and heart. J Thorac Oncol, 2015, 10(9): 1240-1242.
14.	Chu X, Xue Z, Zhang L, et al. Primary report of lobectomy with single utility port complete video-assisted thoracoscopic surgery. Chin J Lung Cancer, 2010, 13(1): 19-21.
15.	中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2022版). 中华医学杂志, 2022, 102(23): 1706-1740.Oncology Society of Chinese Medical Association, Chinese Medical Association Publishing House. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2022 edition). Chin J Med, 2022, 102(23): 1706-1740.
16.	Amuthavalli Thiyagarajan J, Mikton C, Harwood RH, et al. The UN decade of healthy ageing: Strengthening measurement for monitoring health and wellbeing of older people. Age Ageing, 2022, 51(7): afac147.
17.	Chatterji S, Byles J, Cutler D, et al. Health, functioning, and disability in older adults—Present status and future implications. Lancet, 2015, 385(9967): 563-575.
18.	Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM Joint Taskforce on Perioperative Outcome Measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
19.	Fernandez FG, Falcoz PE, Kozower BD, et al. The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: Joint standardization of variable definitions and terminology. Ann Thorac Surg, 2015, 99(1): 368-376.
20.	Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat, 2011, 10(2): 150-161.
21.	耿希华. 经鼻高流量湿化氧疗系统在心胸外科术后急性呼吸衰竭患者中的应用. 山东医药, 2016, 56(45): 94-96.Geng XH. Application of nasal high flow humidified oxygen therapy system in patients with acute respiratory failure after cardiothoracic surgery. Shandong Med, 2016, 56(45): 94-96.
22.	Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
23.	Steenhagen E. Enhanced recovery after surgery: It’s time to change practice! Nutr Clin Pract, 2016, 31(1): 18-29.
24.	Loop T. Fast track in thoracic surgery and anaesthesia: Update of concepts. Curr Opin Anaesthesiol, 2016, 29(1): 20-25.
25.	Giménez-Milà M, Klein AA, Martinez G. Design and implementation of an enhanced recovery program in thoracic surgery. J Thorac Dis, 2016, 8(Suppl 1): S37-S45.
26.	Fernandez-Bustamante A, Frendl G, Sprung J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators. JAMA Surg, 2017, 152(2): 157-166.
27.	Sawada S, Suehisa H, Yamashita M. Inhalation of corticosteroid and β-agonist for persistent cough following pulmonary resection. Gen Thorac Cardiovasc Surg, 2012, 60(5): 285-288.
28.	Poghosyan H, Sheldon LK, Leveille SG, et al. Health-related quality of life after surgical treatment in patients with non-small cell lung cancer: A systematic review. Lung Cancer, 2013, 81(1): 11-26.
29.	Chen J, Peng LH, Min S. Implementation of perioperative breathing exercises and its effect on postoperative pulmonary complications and long-term prognosis in elderly patients undergoing laparoscopic colorectal surgery: A randomized controlled trial. Clin Rehabil, 2022, 36(9): 1229-1243.
30.	Qin PP, Jin JY, Wang WJ, et al. Perioperative breathing training to prevent postoperative pulmonary complications in patients undergoing laparoscopic colorectal surgery: A randomized controlled trial. Clin Rehabil, 2021, 35(5): 692-702.
31.	Okada S, Shimomura M, Ishihara S, et al. Clinical significance of postoperative pulmonary complications in elderly patients with lung cancer. Interact Cardiovasc Thorac Surg, 2022, 35(2): ivac153.
32.	Odor PM, Bampoe S, Gilhooly D, et al. Perioperative interventions for prevention of postoperative pulmonary complications: Systematic review and meta-analysis. BMJ, 2020, 368: m540.
33.	Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care, 2015, 3(1): 15.
34.	沈佳伟, 安友仲. 拔除气管导管后患者的经鼻高流量吸氧治疗. 中华危重病急救医学, 2017, 29(1): 85-89.Shen JW, An YZ. High flow nasal cannula in patients after trachea extubation. Chin Crit Care Med, 2017, 29(1): 85-89.
35.	Ischaki E, Pantazopoulos I, Zakynthinos S. Nasal high flow therapy: A novel treatment rather than a more expensive oxygen device. Eur Respir Rev, 2017, 26(145): 170028.
36.	郭福燕, 冉蕾, 刘会霞, 等. 经鼻高流量湿化氧疗治疗手术机械通气拔管后急性呼吸衰竭及气道管理. 国际呼吸杂志, 2019, 39(6): 429-433.Guo FY, Ran L, Liu HX, et al. Efficacy and airway management of humidified high flow nasal cannula oxygen therapy in treatment of postoperative acute respiratory failure after extubation. Int J Respir, 2019, 39(6): 429-433.
37.	Corley A, Caruana LR, Barnett AG, et al. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth, 2011, 107(6): 998-1004.
38.	Costa Leme A, Hajjar LA, Volpe MS, et al. Effect of intensive vs moderate alveolar recruitment strategies added to lung-protective ventilation on postoperative pulmonary complications: A randomized clinical trial. JAMA, 2017, 317(14): 1422-1432.
39.	Pillow JJ, Hillman NH, Polglase GR, et al. Oxygen, temperature and humidity of inspired gases and their influences on airway and lung tissue in near-term lambs. Intensive Care Med, 2009, 35(12): 2157-2163.
40.	Cuquemelle E, Pham T, Papon JF, et al. Heated and humidified high-flow oxygen therapy reduces discomfort during hypoxemic respiratory failure. Respir Care, 2012, 57(10): 1571-1577.
41.	黄卓泳. 美国医院医疗费用支付、医院质量管理及对我国医改的启示. 中华医学图书情报杂志, 2015, 24(9): 27-30.Huang ZY. Enlightenments of payment for medical care and quality control in hospitals of United States. Chin J Med Libr Inf Sci, 2015, 24(9): 27-30.
42.	Xia M, Li W, Yao J, et al. A postoperative comparison of high-flow nasal cannula therapy and conventional oxygen therapy for esophageal cancer patients. Ann Palliat Med, 2021, 10(3): 2530-2539.

1. Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016. J Nat Cancer Center, 2022, 2(1): 1-9.
2. 毛友生, 赫捷. 肺癌胸腔镜术后并发症的防治策略. 中国肺癌杂志, 2018, 21(3): 230-233.Mao YS, He J. The prevention and management strategy for postoperative complications after thoracoscopic surgery of lung cancer. Chin J Lung Cancer, 2018, 21(3): 230-233.
3. Agostini PJ, Lugg ST, Adams K, et al. Risk factors and short-term outcomes of postoperative pulmonary complications after VATS lobectomy. J Cardiothorac Surg, 2018, 13(1): 28.
4. Sabaté S, Mazo V, Canet J. Predicting postoperative pulmonary complications: Implications for outcomes and costs. Curr Opin Anaesthesiol, 2014, 27(2): 201-209.
5. Kaufmann K, Heinrich S. Minimizing postoperative pulmonary complications in thoracic surgery patients. Curr Opin Anaesthesiol, 2021, 34(1): 13-19.
6. Agostini P, Cieslik H, Rathinam S, et al. Postoperative pulmonary complications following thoracic surgery: Are there any modifiable risk factors? Thorax, 2010, 65(9): 815-818.
7. Shi Q, Wang XS, Vaporciyan AA, et al. Patient-reported symptom interference as a measure of postsurgery functional recovery in lung cancer. J Pain Symptom Manage, 2016, 52(6): 822-831.
8. Fagundes CP, Shi Q, Vaporciyan AA, et al. Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory. J Thorac Cardiovasc Surg, 2015, 150(3): 613-619.
9. Ansari BM, Hogan MP, Collier TJ, et al. A randomized controlled trial of high-flow nasal oxygen (optiflow) as part of an enhanced recovery program after lung resection surgery. Ann Thorac Surg, 2016, 101(2): 459-464.
10. 中华医学会呼吸病学分会呼吸危重症医学学组, 中国医师协会呼吸医师分会危重症医学工作委员会. 成人经鼻高流量湿化氧疗临床规范应用专家共识. 中华结核和呼吸杂志, 2019, 42(2): 83-91.Respiratory & Critical Care Medicine Group of Chinese Thoracic Society, Respiratory & Critical Care Medicine Committee of Chinese Association of Chest Physician. Expert consensus of high-flow nasal cannula oxygen therapy on clinical application regularity. Chin J Tuberc Respir Dis, 2019, 42(2): 83-91.
11. Pennisi MA, Bello G, Congedo MT, et al. Early nasal high-flow versus Venturi mask oxygen therapy after lung resection: A randomized trial. Crit Care, 2019, 23(1): 68.
12. Detterbeck FC, Boffa DJ, Kim AW, et al. The eighth edition lung cancer stage classification. Chest, 2017, 151(1): 193-203.
13. Travis WD, Brambilla E, Burke AP, et al. Introduction to the 2015 World Health Organization classification of tumors of the lung, pleura, thymus, and heart. J Thorac Oncol, 2015, 10(9): 1240-1242.
14. Chu X, Xue Z, Zhang L, et al. Primary report of lobectomy with single utility port complete video-assisted thoracoscopic surgery. Chin J Lung Cancer, 2010, 13(1): 19-21.
15. 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2022版). 中华医学杂志, 2022, 102(23): 1706-1740.Oncology Society of Chinese Medical Association, Chinese Medical Association Publishing House. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2022 edition). Chin J Med, 2022, 102(23): 1706-1740.
16. Amuthavalli Thiyagarajan J, Mikton C, Harwood RH, et al. The UN decade of healthy ageing: Strengthening measurement for monitoring health and wellbeing of older people. Age Ageing, 2022, 51(7): afac147.
17. Chatterji S, Byles J, Cutler D, et al. Health, functioning, and disability in older adults—Present status and future implications. Lancet, 2015, 385(9967): 563-575.
18. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM Joint Taskforce on Perioperative Outcome Measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
19. Fernandez FG, Falcoz PE, Kozower BD, et al. The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: Joint standardization of variable definitions and terminology. Ann Thorac Surg, 2015, 99(1): 368-376.
20. Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat, 2011, 10(2): 150-161.
21. 耿希华. 经鼻高流量湿化氧疗系统在心胸外科术后急性呼吸衰竭患者中的应用. 山东医药, 2016, 56(45): 94-96.Geng XH. Application of nasal high flow humidified oxygen therapy system in patients with acute respiratory failure after cardiothoracic surgery. Shandong Med, 2016, 56(45): 94-96.
22. Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
23. Steenhagen E. Enhanced recovery after surgery: It’s time to change practice! Nutr Clin Pract, 2016, 31(1): 18-29.
24. Loop T. Fast track in thoracic surgery and anaesthesia: Update of concepts. Curr Opin Anaesthesiol, 2016, 29(1): 20-25.
25. Giménez-Milà M, Klein AA, Martinez G. Design and implementation of an enhanced recovery program in thoracic surgery. J Thorac Dis, 2016, 8(Suppl 1): S37-S45.
26. Fernandez-Bustamante A, Frendl G, Sprung J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study by the perioperative research network investigators. JAMA Surg, 2017, 152(2): 157-166.
27. Sawada S, Suehisa H, Yamashita M. Inhalation of corticosteroid and β-agonist for persistent cough following pulmonary resection. Gen Thorac Cardiovasc Surg, 2012, 60(5): 285-288.
28. Poghosyan H, Sheldon LK, Leveille SG, et al. Health-related quality of life after surgical treatment in patients with non-small cell lung cancer: A systematic review. Lung Cancer, 2013, 81(1): 11-26.
29. Chen J, Peng LH, Min S. Implementation of perioperative breathing exercises and its effect on postoperative pulmonary complications and long-term prognosis in elderly patients undergoing laparoscopic colorectal surgery: A randomized controlled trial. Clin Rehabil, 2022, 36(9): 1229-1243.
30. Qin PP, Jin JY, Wang WJ, et al. Perioperative breathing training to prevent postoperative pulmonary complications in patients undergoing laparoscopic colorectal surgery: A randomized controlled trial. Clin Rehabil, 2021, 35(5): 692-702.
31. Okada S, Shimomura M, Ishihara S, et al. Clinical significance of postoperative pulmonary complications in elderly patients with lung cancer. Interact Cardiovasc Thorac Surg, 2022, 35(2): ivac153.
32. Odor PM, Bampoe S, Gilhooly D, et al. Perioperative interventions for prevention of postoperative pulmonary complications: Systematic review and meta-analysis. BMJ, 2020, 368: m540.
33. Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care, 2015, 3(1): 15.
34. 沈佳伟, 安友仲. 拔除气管导管后患者的经鼻高流量吸氧治疗. 中华危重病急救医学, 2017, 29(1): 85-89.Shen JW, An YZ. High flow nasal cannula in patients after trachea extubation. Chin Crit Care Med, 2017, 29(1): 85-89.
35. Ischaki E, Pantazopoulos I, Zakynthinos S. Nasal high flow therapy: A novel treatment rather than a more expensive oxygen device. Eur Respir Rev, 2017, 26(145): 170028.
36. 郭福燕, 冉蕾, 刘会霞, 等. 经鼻高流量湿化氧疗治疗手术机械通气拔管后急性呼吸衰竭及气道管理. 国际呼吸杂志, 2019, 39(6): 429-433.Guo FY, Ran L, Liu HX, et al. Efficacy and airway management of humidified high flow nasal cannula oxygen therapy in treatment of postoperative acute respiratory failure after extubation. Int J Respir, 2019, 39(6): 429-433.
37. Corley A, Caruana LR, Barnett AG, et al. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth, 2011, 107(6): 998-1004.
38. Costa Leme A, Hajjar LA, Volpe MS, et al. Effect of intensive vs moderate alveolar recruitment strategies added to lung-protective ventilation on postoperative pulmonary complications: A randomized clinical trial. JAMA, 2017, 317(14): 1422-1432.
39. Pillow JJ, Hillman NH, Polglase GR, et al. Oxygen, temperature and humidity of inspired gases and their influences on airway and lung tissue in near-term lambs. Intensive Care Med, 2009, 35(12): 2157-2163.
40. Cuquemelle E, Pham T, Papon JF, et al. Heated and humidified high-flow oxygen therapy reduces discomfort during hypoxemic respiratory failure. Respir Care, 2012, 57(10): 1571-1577.
41. 黄卓泳. 美国医院医疗费用支付、医院质量管理及对我国医改的启示. 中华医学图书情报杂志, 2015, 24(9): 27-30.Huang ZY. Enlightenments of payment for medical care and quality control in hospitals of United States. Chin J Med Libr Inf Sci, 2015, 24(9): 27-30.
42. Xia M, Li W, Yao J, et al. A postoperative comparison of high-flow nasal cannula therapy and conventional oxygen therapy for esophageal cancer patients. Ann Palliat Med, 2021, 10(3): 2530-2539.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prophylactic high-flow nasal cannula oxygen therapy can reduce postoperative pulmonary complications in elderly patients with non-small cell lung cancer: A propensity score matching study

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