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

作者：Bu Long, Yahong Liu, Furong Lin, Yaoliang Zhang, Guilin Peng, Chao Yang, Sida Liao, Lan Lan · 发表于：The Annals of Thoracic Surgery · 年份：2025 · DOI：10.1016/j.athoracsur.2025.11.020 · 被引用次数：6 · 研究领域：Airway Management and Intubation Techniques、Anesthesia and Sedative Agents、Enhanced Recovery After Surgery

BACKGROUND: 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. METHODS: 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. RESULTS: 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), w...