Effect of postextubation high-flow oxygen on oxygen saturation during transit from operation theater to postoperative ward – A randomized, prospective comparative study

Abstract

Background and Aims: Postoperative pulmonary complications (PPCs) increase morbidity and mortality. The risk of developing PPC starts immediately after extubation. Transport time is the most influential time for the development of hypoxia. In early postoperative period, there is a decrement in PaO2 by 7–18 mmHg from baseline and may lead to severe hypoxia. This can be attributed to diffusion hypoxia, residual effect of anesthetics, pain, and impaired hemodynamics. To prevent this hypoxia, oxygen is almost invariably given with low-flow devices immediately after extubation. We conducted this trial to know the effect of postextubation high-flow oxygen on peripheral oxygen saturation during transit from operation theater to postanesthesia care unit compared to conventional oxygen therapy. Our primary outcome was to estimate and compare the incidence of desaturation in both the groups, whereas the secondary outcome was to compare time to desaturation. Methodology: A total of 156 patients were randomly allocated to receive either high-flow or conventional oxygen for 5 min immediately after extubation. Patients were shifted to postoperative ward without oxygen supplementation. Transport time, incidence of desaturation, and time required for desaturation were noted. Results: In the high-flow oxygen group, 15.6% of patients had desaturation compared to 26.9% in the conventional group. The average time for desaturation was 3.2 ± 1.7 min in the high-flow oxygen group compared to the conventional group in whom it was 2.6 ± 1.7 min, although this difference was not statistically significant. Conclusion: The incidence of desaturation was less, whereas the time taken for desaturation was longer with the use of high flow compared to conventional oxygen therapy following extubation.

Keywords

• extubation
• hypoxia
• oxygen
• postoperative