title: Comparative evaluation of high-flow nasal cannula and conventional oxygen therapy in paediatric cardiac surgical patients: a randomized controlled trial.
abstract: OBJECTIVE
  The aim of this study was to compare high-flow nasal cannula (HFNC) and conventional O2 therapy (OT) in paediatric cardiac surgical patients; the primary objective of the study was to evaluate whether HFNC was able to improve PaCO2 elimination in the first 48 h after extubation postoperatively.
  
  
  METHODS
  We conducted a randomized, controlled trial in pediatric cardiac surgical patients under 18 months of age. At the beginning of the weaning of ventilation, patients were randomly assigned to either of the following groups: OT or HFNC. Arterial blood samples were collected before and after extubation at the following time points: 1, 6, 12, 24 and 48 h. The primary outcome was comparison of arterial PaCO2 postextubation; secondary outcomes were PaO2 and PaO2/fractional inspired oxygen (FiO2) ratio, rate of treatment failure and need of respiratory support, rate of extubation failure, rate of atelectasis, simply to complications and the length of paediatric cardiac intensive care unit stay.
  
  
  RESULTS
  Demographic and clinical variables were comparable in the two groups. Analysis of variance for repeated measures showed that PaCO2 was not significantly different between the HFNC and OT groups (P = 0.5), whereas PaO2 and PaO2/FiO2 were significantly improved in the HFNC group (P = 0.01 and P = 0.001). The rate of reintubation was not different in the two groups (P = 1.0), whereas the need for noninvasive respiratory support was 15% in the OT group and none in the HFNC group (P = 0.008).
  
  
  CONCLUSIONS
  HFNC had no impact on PaCO2 values. The use of HFNC appeared to be safe and improved PaO2 in paediatric cardiac surgical patients.
authors.affiliation: Department of Pediatric Cardiac Anesthesia and Intensive, Children's Hospital Bambino Gesu', Rome, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Testa
authors.affiliation: Department of Pediatric Cardiac Anesthesia and Intensive, Children's Hospital Bambino Gesu', Rome, Italy francesca_iodice@yahoo.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Iodice
authors.affiliation: Department of Pediatric Cardiac Anesthesia and Intensive, Children's Hospital Bambino Gesu', Rome, Italy.
authors.forename: Zaccaria
authors.initials: Z
authors.lastname: Ricci
authors.affiliation: Department of Pediatric Cardiac Anesthesia and Intensive, Children's Hospital Bambino Gesu', Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vitale
authors.affiliation: Department of Pediatric Cardiac Anesthesia and Intensive, Children's Hospital Bambino Gesu', Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: De Razza
authors.affiliation: Department of Pediatric Cardiac Anesthesia and Intensive, Children's Hospital Bambino Gesu', Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Haiberger
authors.affiliation: Department of Pediatric Cardiac Anesthesia and Intensive, Children's Hospital Bambino Gesu', Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Iacoella
authors.affiliation: Pediatric Intensive Care Unit, Policlinico A. Gemelli, Catholic University of Rome Italy, Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.affiliation: Department of Pediatric Cardiac Anesthesia and Intensive, Children's Hospital Bambino Gesu', Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Cogo
mesh_terms: D000367:Age Factors; D060666:Airway Extubation; D001784:Blood Gas Analysis; D006348:Cardiac Surgical Procedures; D057785:Catheters; D004867:Equipment Design; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007558:Italy; D007902:Length of Stay; D008168:Lung / Q000503:physiopathology*; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000295:instrumentation*; D011182:Postoperative Care; D011446:Prospective Studies; D020127:Recovery of Function; D012119:Respiration; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning
keywords: Cardiac; High-flow nasal cannula; Paediatric