Randomized Trial of High-Flow Nasal Cannula vs Double-Lumen Endotracheal Tube or Laryngeal Mask for Thoracoscopic Surgery.

Abstract

High-flow nasal cannula (HFNC) oxygen therapy is widely used primarily for preoxygenation and postextubation respiratory support. However, its intraoperative application remains uncommon. This study evaluated the effects of the HFNC on respiratory mechanics and hemodynamics in thoracoscopic surgery under spontaneous ventilation. This randomized trial included 165 patients scheduled for thoracoscopic surgery from 2023 to 2024. Patients were assigned to 3 ventilation supports: double-lumen endotracheal tube (intubation group, n = 55), laryngeal mask airway group (n = 55), or HFNC (n = 55). Intraoperative respiratory and hemodynamic changes, postoperative recovery, and adverse effects were analyzed. The oxygenation index was comparable intraoperatively but higher in the HFNC group 5 minutes after extubation (P = .018). Intraoperative carbon dioxide was higher in the HFNC and laryngeal mask airway groups (P < .05) but gradually normalized postoperatively. The HFNC shortened extubation time (30 vs 33 vs 37 minutes; P = .005) and postoperative anesthesia care unit stay (70 vs 75 vs 85 minutes; P < .001) and reduced the incidence of nausea, sore throat, and dizziness in the 24 hours postoperatively (P = .005, P = .001, P = .002). HFNC patients demonstrated improved early mobility and nocturnal sleep and lower numeric pain rating scale score at rest and during activity (P < .05). Propofol and opioid use was lower in the HFNC group (P = .016, P < .001), whereas dexmedetomidine consumption was higher (P = .002). The HFNC provides a stable form of anesthesia compared with laryngeal mask and intubation and is associated with early improved rehabilitation in thoracoscopic surgery.