Prophylactic high-flow nasal oxygen vs. conventional oxygen for prevention of postoperative respiratory complications: a randomized trial
In brief
High-flow oxygen lowered moderate-to-severe complications from 40% to 23% after lung surgery
In a randomized trial of 210 older adults having minimally invasive lung cancer surgery, high-flow nasal oxygen reduced moderate-to-severe postoperative lung complications from 40% with conventional oxygen to 23%. Early respiratory symptoms also appeared better, but physiological outcomes and hospital stay did not change, and the single-center findings do not support routine use for every patient.
- Journal
- Critical care (London, England) (Q1)
- Published
- 20 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Rongjia Lin, Yangyun Huang, Genmiao Yu, Mei Lei, Yanqing Chen, Chunmei Xiang, et al.
- PMID
- 42864673
- DOI
- 10.1186/s13054-026-06205-4
Why clinicians should know about it
- Picked for Pulmonary and Respiratory Medicine (top studies of the week, 25 October 2026): prophylactic HFNC reduced postoperative respiratory complications
Abstract
BACKGROUND: Postoperative pulmonary complications (PPCs) are a major cause of morbidity after lung resection, particularly in older adults. Following extubation, noninvasive respiratory support strategies are increasingly used to prevent respiratory deterioration, but the role of prophylactic high-flow nasal cannula (HFNC) in this setting remains uncertain. METHODS: In this single-center, open-label randomized controlled trial, patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy for stage I-IIIa non-small cell lung cancer (NSCLC) were randomized to HFNC or conventional oxygen therapy (COT). The primary outcome was PPC severity during hospitalization, analyzed using ordinal logistic regression; the incidence of clinically relevant PPCs (grade ≥ 2) was also compared between groups. Secondary outcomes included longitudinal respiratory symptoms (mMRC, LCQ-MC, sCSS) and symptom-related functional interference (MDASI-LC), analyzed using mixed-effects models. RESULTS: A total of 210 patients were included in the modified intention-to-treat analysis (HFNC, n = 104; COT, n = 106). HFNC reduced PPC severity (ordinal OR, 0.50; 95% CI, 0.28-0.91; P = 0.022) and moderate-to-severe PPCs (23.1% vs. 39.6%; absolute risk difference, -15.6%; 95% CI, -28.0% to -3.2%; P = 0.010). HFNC was associated with a lower burden of clinically relevant PPCs. Secondary analyses also suggested improvements in early postoperative respiratory symptoms and symptom-related functional interference. Secondary analyses also suggested improvements in early postoperative respiratory symptoms and symptom-related functional interference. No differences were observed in physiological outcomes or length of stay. CONCLUSION: In older adults undergoing lung resection, prophylactic HFNC reduced in-hospital PPC burden and was associated with more favorable early postoperative respiratory recovery. These findings suggest that prophylactic HFNC may provide benefit as a potential preventive respiratory support option in selected older or higher-risk postoperative patients, although routine prophylactic use in all patients undergoing lung resection is not supported by the present findings. TRIAL REGISTRATION: This study was approved by the Chinese Clinical Trial Registry (ChiCTR2200063161) on 01 Sep 2022 and the first patient was enrolled after pre-registration.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.