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EFFECTS OF HIGH-FLOW NASAL CANNULA IN THE POSTOPERATIVE
PERIOD OF PEDIATRIC CARDIAC SURGERY: SCOPING REVIEW
Mariany Amorim Bonm1
Jéssica Vitória Brito dos Santos2
Isis Nunes Veiga3
Abstract: INTRODUCTION: The use of High Flow Nasal Cannula (HFNC) in children after cardiac
surgery may offer benets that are observed based on blood gas analysis, vital signs and a reduction
in the reintubation rate. The use begins with a clinical picture of acute respiratory failure culminating
in the presence of some symptoms. The use of HFNC improves the respiratory condition after
extubation and mainly by preventing extubation failures, reducing reintubation rates and preventing
atelectasis. OBJECTIVE: To map the hemodynamic and clinical effects of High Flow Nasal Cannula
in the postoperative period of pediatric cardiac surgery. METHODS: Scoping review that followed
the PRISMA-ScR recommendations, using the PubMed, SciELO, Virtual Health Library, Lilacs,
PEDro, Embase and Cochrane Library databases. Articles that evaluated the hemodynamic and
clinical effects of HFNC in the postoperative period of cardiac surgeries were included and articles
in which children had comorbidities associated with heart disease, reviews, case reports, opinion
articles and articles that were not available in full were excluded. RESULTS: six articles addressed
and analyzed relevant hemodynamic and clinical outcomes, such as PaO2, PCO2, SpO2, PaO2/FiO2,
BP, HR, RR, CEC, treatment failure, extubation failure, reintubation rate, length of hospital stay or
ICU stay, and atelectasis rate. CONCLUSION: The ndings of this study indicate a tendency for the
1 Student of Physiotherapy at Bahiana – Bahiana School of Medicine and Public Health, Bahia,
Brazil. ORCID: 0009-0001-5379-4380
2 Student of Physiotherapy at Bahiana – Bahiana School of Medicine and Public Health, Bahia,
Brazil. ORCID: 0009-0006-2270-7447.
3 Physiotherapist, PhD in Family in Contemporary Society, Full Professor at the Bahiana School
of Medicine and Public Health, Bahia, Brazil. ORCID: 0000-0002-1931-1111
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therapy analyzed to contribute to the improvement of PaO2, PCO2, reintubation rate and reduction of
hospital stay in the postoperative period of pediatric cardiac surgery.
Keywords: cardiac surgery. Postoperative period. Pediatrics. Respiratory physiotherapy.
INTRODUCTION
Cardiac surgeries (CCs) are complex procedures that generate major changes in the body’s
physiological mechanism (Araújo et al., 2020; Original et al., 2011) . In Brazil, the prevalence is
about 28 thousand cases per year of congenital heart disease (CHD), which are an abnormality in the
structure of the heart that have functional repercussions. It affects approximately 8 to 10 children per
1000 live births, with higher rates in the North and Northeast regions and lower rates in the South and
Southeast regions. (Borges et al., 2010; Pinto Júnior et al., 2004; Silva et al., 2021)
Among the most relevant repercussions in the postoperative context of cardiac surgeries
(POCC), respiratory complications stand out, which may be related to several factors such as the
use of cardiopulmonary bypass (CPB), effects of anesthesia, surgical incision, intensity of surgical
manipulation, thoracic trauma, number of drains, hypoxemia, atelectasis, and ischemia time. In
addition, the extubation procedure occurs 6 hours after surgery, making most of these patients require
non-invasive ventilatory support. Thus, the high-ow nasal cannula (HFNC), a non-invasive support,
emerges as a way to contribute to the extubation process by helping in the clinical condition of these
patients. (Araújo et al., 2020; Borges et al., 2010; Silva et al., 2021)
HFNC is a non-invasive high-ow system that delivers a mixture of air and oxygen through
a circuit of humidied gases heated at high speeds through a nasal cannula ranging from 2 to 50 L/
min according to the child’s age group and weight. The HFNC mechanism allows the elimination of
dead space by generating a reservoir of fresh gas in the nasopharynx and reducing the rebreathing
of carbon dioxide, with a reduction in respiratory rate (RR) and respiratory effort due to inspiratory
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resistance; It improves airway conduction, mucociliary transport, and lung compliance by preventing
airway dryness (Bocchile et al., 2018; Dysart et al., 2009; Slain ; Shein ; Rotta, 2017) .
Therefore, the use of HFNC in children in the postoperative period of cardiac surgery may
offer benets when compared with NIV and treatment with conventional oxygen therapy, and can be
observed based on parameters such as blood gas analysis, vital signs, and reduction in the reintubation
rate. Its use is indicated based on a clinical picture of acute respiratory failure with the presence of
symptoms such as tachypnea, hypoxemia, hypercapnia, and increased work of breathing using the
post-extubation accessory muscles. Studies have shown that HFNC improves the respiratory condition
after extubation in pediatric cardiac surgery, with wide acceptance and popularity mainly because
it prevents extubation failures, decreases reintubation rates, prevents atelectasis, and is a simple and
(Araújo et al., 2020; Shioji et al., 2019; Silva et al., 2021; Testa et al., 2014) (Araújo et al., 2020)
safe resource. ( Bocchile et al., 2018; Shioji et al., 2017, 2019; Silva et al., 2021; Testa et al.,
2014)
Due to the respiratory complications in the postoperative period of pediatric cardiac surgeries
and the need for interventions that favor a safe and effective recovery, a study is needed to verify the
postoperative effects of HFNC in this population, hemodynamically and clinically evaluating the
impacts. Considering that HFNC has promising physiological mechanisms, its use may represent
a signicant advance in post-extubation respiratory management. In addition, it can contribute to
support more effective, safe, and targeted therapeutic protocols for the pediatric reality. Therefore, the
objective of this study was to map the hemodynamic and clinical effects of HFNC in the postoperative
period of pediatric cardiac surgery.
MATERIAL AND METHODS
This is a scoping review following the recommendations of the extension for Scoping
Reviews of the Preferred Reporting Items for Systemtic Reviews and Meta-Analyses Protocols
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(PRISMA-ScR). We included studies that evaluated the hemodynamic and clinical effects of HFNC
in the postoperative period of pediatric cardiac surgeries or that described the length of hospital stay
and reintubation rate, with no time limit and no language restriction. On the other hand, articles in
which the children had comorbidities associated with heart disease, narrative or systematic reviews,
opinion articles, case reports, as well as publications whose full text was not available were excluded.
( Knitting et al., 2018)
The databases used to select the studies were PubMed, SciELO, Virtual Health Library,
Lilacs, PEDro, Cochrane Library and Embase. The descriptors in Portuguese were: high-ow nasal
cannula, HFNC, postoperative, postoperative period, cardiac surgery, and children. Respectively
reproduced for the English language high ow nasal cannula, HFNC, postoperative, postoperative
period, Heart surgery/ Cardiac surgery and pediatrics/children.
The selection of descriptors was made through the MeSh (Medical Subject Headings)
using the PICO strategy: Population: children in the postoperative period of cardiac surgery;
Intervention:CNAF; Control: Control; Outcome: hemodynamic and clinical picture, and Boolean
operators “OR” and “AND”. The search strategy was carried out in the period from September to
October 2024 (Chart 1), followed by the collection of articles from December 2024 to March 2025.
Chart 1 – Search Strategy
Database Search strategy
PubMed
SciELO
Virtual Health Library
((high ow nasal cannula) or (High-ow nasal cannula) or (High Flow
Nasal Cannula) or (HFNC) AND (Postoperative) or (Postoperative
Period) AND (Heart Surgery) OR (Surgery, Heart) OR (Cardiac Surgery)
OR (Cardiac Surgical Procedure) OR (Heart Surgical Procedure) AND
(Pediatrics) OR (Children) OR (Child))
VHL/Lilacs (lter) ((high ow nasal cannula) or (High-ow nasal cannula) or (High Flow
Nasal Cannula) or (HFNC) AND (Postoperative) or (Postoperative
Period) AND (Heart Surgery) OR (Surgery, Heart) OR (Cardiac Surgery)
OR (Cardiac Surgical Procedure) OR (Heart Surgical Procedure) AND
(Pediatrics) OR (Children) OR (Child))
Peter ((High Flow Nasal Cannula Postoperative Heart surgery Pediatrics))
((High Flow Nasal Cannula Heart surgery Pediatrics))
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Cochrane Library (high ow nasal cannula) AND (“postoperative”) AND (“cardiac
surgery”) AND (“Child”)
Embase (‘High Flow Nasal Cannula Therapy’) AND (‘postoperative period’)
AND (‘heart surgery’) AND (‘pediatrics’)
Source: Authorship.
The team responsible for selecting the scientic evidence consisted of two researchers, with
the inclusion of a more experienced reviewer, in charge of resolving disagreements. The selection of
scientic evidence consisted of three phases, the rst included the denition of keywords, the second
was the screening of the titles and abstracts identied in the databases, and the last phase was carried
out a complete reading of potentially eligible articles. To organize the records and ensure greater
transparency, blinding was carried out between the pairs.
The two reviewers independently lled out a database prepared in Excel®, which had the
following variables: authors, year of publication, title, selected database, study design, objectives,
population, methods, and results.
Finally, the results were expressed in tables, charts and gures, where categorical variables
(such as treatment failure, extubation failure and reintubation rate) and numerical variables (partial
pressure of oxygen, partial pressure of carbon dioxide, blood pressure, ratio of partial pressure of
oxygen in arterial blood and fraction of inspired oxygen, heart rate, respiratory rate, peripheral
oxygen saturation, length of hospital stay or ICU stay, atelectasis rate, cardiopulmonary bypass).
FINDINGS
A total of 46 articles were found in the databases, of which 16 were eligible for reading in
full. In the end, 6 articles were included because they met the eligibility criteria (Figure 1).
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Figure 1: Flowchart selection of studies for new reviews that included searches in databases, registries
and other sources.
The characterization of the studies, together with the description of the objective, sample,
and clinical outcomes are described in Table 1. The relationship between the year of publication of
the included articles and the perspective quantity per year is shown in Graph 1, with the retrospective
observational study being the most predominant, with 3 articles included in Graph 2. The hemodynamic
effects such as partial pressure of arterial blood oxygen (PaO2), partial pressure of arterial blood
carbon dioxide (PCO2), ratio between partial pressure of arterial blood oxygen and fraction of inspired
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oxygen (PaO2/FiO2), blood oxygen saturation (SpO2), respiratory rate (RR), heart rate (HR), mean
arterial pressure (BP), (Graph 3). (Testa et al., 2014; Zheng; Chen; Zhou, 2023) ( Enayati et
al., 2021; Itagaki et al., 2019; Testa et al., 2014; Zheng; Chen; Zhou, 2023) ( Enayati et al., 2021;
Testa et al., 2014) (Zheng; Chen; Zhou, 2023) (Zheng; Chen; Zhou, 2023)
The remaining studies analyzed outcomes such as reintubation rate, atelectasis rate, and
length of hospital stay at different times after HFNC use. In addition, one study addresses treatment
failure compared to other therapies, another on cardiopulmonary bypass, treatment failure, and
extubation failure (Graph 3). ( Enayati et al., 2021; Öztürk et al., 2024; Testa et al., 2014) (
Öztürk et al., 2024) ( Enayati et al., 2021; Richter et al., 2019; Testa et al., 2014) (Testa et al.,
2014) ( Enayati et al., 2021) (Testa et al., 2014) (Richter et al., 2019)
Graph 1: Distribution of the year of publication in the included studies.
Source: Prepared by the authors.
1
2
111
2014 2019 2021 2023 2024
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Graph 2: Distribution of the study design evaluated in the included studies.
Source: Prepared by the authors.
Graph 3: Distribution of the clinical variables evaluated in the included studies.
Source: Prepared by the authors.
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Author and year Type of study Goal Sample Outcomes
Yi-Rong Zheng et
al.,2023
Retrospective cohort To compare the efcacy and safety
of high-ow nasal cannula (HFNC)
and conventional oxygen therapy
(TOC) in beroptic bronchoscopy
(FB) after congenital heart surgery
(CHS) in children.
Children undergoing FB after
simple CHS (ventricular septal
defect, patent atrial septal defect,
or patent ductus arteriosus) in the
cardiac intensive care unit (ICU)
from May 2021 to May 2022.
During the examination, the TcPCO2 (transcutaneous carbon
dioxide tension) rate: lower in the HFNC group than in the
COT (conventional oxygen therapy) group (39.6±3.0 vs 43.5±3.9
mm Hg, p<0.001). During the examination, the rate of TcPO2
(transcutaneous oxygen tension): higher in the HFNC group than
in the COT group (TcPO2: 90.3±9.3 vs 80.6±11.1 mm Hg). During
the test, SpO2 (oxygen saturation): higher in the HFNC group than
in the TOC group (SpO2: 95.6±2.5 vs 92.1%±2.0%; p<0.001). RR,
HR, MAP (mean arterial pressure), SpO2, TcPO2 and TcPCO2:
there was no signicant difference between the two groups 30 min
before and after the test (p>0.05).
Erkut Öztürk et
al., 2024
Retrospective
observational
To evaluate the potential positive
effects of HFNC treatment in
the prevention of postoperative
atelectasis and reintubation in
pediatric cardiac surgery patients.
Full-term newborns and infants
under 6 months of age who
underwent congenital heart
surgery from November 1, 2022
to November 1, 2023 and were
followed in the pediatric cardiac
ICU.
Reintubation rates in the rst 72 hours: in HFNC users, one patient
(2.5%) and non-HFNC users were ve patients (12.5%) (p < 0.05).
The 24-hour reintubation rates: HFNC users one patient (2.5%)
and non-HFNC users were three patients (7.5%). Reintubation
rates at 48 hours: HFNC users one patient (2.5%) and non-HFNC
users ve patients (12.5%). Rates of postoperative atelectasis at
24 hours: median scores 2 for HFNC users and 2.5 for non-HFNC
users (p > 0.05). Postoperative atelectasis rates at 48 hours: median
scores 1.5 for HFNC users and 3.5 for non-HFNC users (p < 0.05).
Postoperative atelectasis rates at 72 hours: median scores 1 for
HFNC users and 3 for non-HFNC users (p < 0.05).
Taiga Itagaki et
al., 2019
Prospective Crusader To determine whether HFNC
improved thoraco-abdominal
synchrony in pediatric subjects with
mild to moderate respiratory failure
after cardiac surgery.
Pediatric subjects with a body
weight of 2–10 kg; subjects with
mild to moderate respiratory
failure who experienced one
or more of the following
after extubation: SpO2< 95%
without supplemental oxygen
(for acyanotic heart disease);
respiratory rate > 50 breaths/
min; asynchronous or paradoxical
breathing pattern.
Respiratory rate, maximal compartment amplitude/VT, phase
angle, and minute volume decreased signicantly by 2 L/kg/min
(P < 0.05 for all), but not by 1 L/kg/min. Pac02 had no difference
between oxygen therapies.
Table 1 - Methodological characterization and main clinical outcomes of the included studies (author/
year of publication, type of study, objective, sample, and outcome). Salvador/BA- Brazil, 2025.
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Giuseppina Testa
et al., 2014
Randomized controlled
trial
The aim of this study was to
compare high-ow nasal cannula
(HFNC) and conventional O2
therapy (OT) in pediatric patients
undergoing cardiac surgery; Main
objective: to evaluate whether
HFNC was able to improve PaCO2
elimination in the rst 48 hours
a f t e r p o s t o p e r a t i v e e x t u b a t i o n .
Secondary objectives: to evaluate
whether HFNC compared with OT
was able to improve the following
parameters: PaO2 and PAO2/FIO2
values at different time points up
to 48 h after extubation; the rate of
treatment failure for respiratory or
cardiac reasons; the need for post-
extubation respiratory support; the
rate of extubation failure; the rate of
pulmonary atelectasis documented
by a radiologist who compared
the chest X-ray before extubation
with the one performed 12 hours
after extubation; development
of complications related to nasal
prongs dened as nasal ulcers,
gastric distention, and need for
supplemental sedation; length of
stay in the PICU.
Pediatric cardiac surgical patients
less than 18 months of age.
PaCO2: values at baseline were not signicantly different between
the HFNC and conventional oxygen therapy groups (P = 0.64),
and the values remained similar in the two groups throughout
the study period (P = 0.5). PaO2: values at baseline were similar
(P = 0.5) and signicantly higher in the HFNC group at 6.12, 24,
and 48 hours post-extubation (P = 0.01, at all time points). The
PaO2/FiO2:values ratio were similar at baseline (P = 0.45) and
signicantly higher in the HFNC group at post-extubation hours
(P < 0.001 at all time points). Reintubation rate: 4.6% in the HFNC
group (2 patients) and 4.3% (2 patients) in the conventional oxygen
therapy group (P = 1.0). The median length
of stay in the PICU: 4.5 days (IQR 2–7 days) in the HFNC group
and 5 days (IQR 3–9 days) in the conventional oxygen therapy
group (P = 0.56). Treatment failure: there was none in the HFNC
group (P = 0.008) and in the conventional oxygen therapy group
it was 15% (7 patients, 6 patients for respiratory reasons and 1 for
cardiac reasons). All patients with treatment failure required a non-
invasive form of respiratory support.
Robert P Richter
et al.,2019
Retrospective cohort To describe the impact of
postoperative respiratory support
with PAP versus HFNC in infants
with congenital heart disease.
Primary objective: to explore the
impact of the initial respiratory
modality on the extubation failure
rate. Secondary objective: To
evaluate the association of post-
extubation respiratory support
mode with the utilization of post-
surgical resources, including the
total duration of respiratory support
(i.e., time to reach low-ow nasal
cannula- LFNC and room air).
Patients less than 6 months of
age admitted to the Children’s
of Alabama ICU between July 1,
2012, and June 30, 2015, following
congenital heart surgery that
required cardiopulmonary bypass
(CPB) via open sternotomy.
Extubation failure (up to 48 hours): 10% (5 patients) with HFNC, |
16% (8 patients) with PAP, P= 0.549. *The rate of extubation failure
did not differ signicantly between the groups that used support
with indication of respiratory failure (n=21), shock (n=6), cardiac
arrest (n=3), and altered mental status (n=1). Postoperative hospital
stay (days): 14% (7–23) for HFNC, 22% (10.5–29) for PAP use,
P=0.015 (Signicant).
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Farzaneh Enayati
et al., 2021
Randomized controlled
clinical trial
To evaluate the effect of high-ow
nasal cannula (HFNC) after early
extubation in children undergoing
cardiac surgery.
Children aged 1 to 24 months
undergoing cardiac surgery from
March 5 to August 30, 2020, in
an intensive care unit (ICU) post-
pediatric cardiac surgery.
Cardiopulmonary bypass: HFNC: 78.79 ± 23.06 CONTROL: 75 ±
21.52 p=0.442).
*After surgery, the incidence of respiratory failure decreased in
both groups, with no signicant difference between them (p >
0.05).
*Before surgery - HFNC: 31 (60.8), control: 20 (50) p-value = 0.957.
*On entry into the ICU-HFNC: 22 (25.9) control: 9 (10.6) p-value
= 0.497.
PaO2/FiO2: values were similar before extubation in both groups
(P > 0.05).
The HFNC group had the best values than the control group after
extubation (P > 0.05);
*The groups had a statistical difference at 1 hour after extubation,
6 hours, 12 hours, 24 hours and 36 hours after extubation, and the
mean and standard deviation of the HFNC group was better/lower
mainly at 1 hour, 24 hours and 36 hours after extubation.
PCO2: similar before extubation in both groups (P > 0.05) and
was lower in the HFNC group compared to the control group after
extubation (P > 0.05), and the mean and standard deviation of the
HFNC group was better/lower mainly at 6 hours, 24 hours and 36
hours after extubation.
Incidence
rates of reintubation were 9.6% in the HFNC group and 47.5% in
the control group, (P < 0.013).
ICU length of stay: patients had a shorter length of stay in the HFNC
group (2.55 ± 0.53 days) than in the control group (3.34 ± 0.59 days)
(P<0.0 01).
HFNC: High-ow nasal cannula; TOC: Conventional oxygen therapy; FB: Optical ber; CHS: Congenital heart surgery; TCPCO2:
Transcutaneous carbon dioxide tension; OCT2: Transcutaneous oxygen tension; PACO2/ PCO2: Partial pressure of carbon dioxide;
PAO2: Partial pressure of oxygen; SPO2: Oxygen saturation; PAO2 /FIO2: Ratio between the partial pressure of arterial oxygen and
the fraction of inspired oxygen; RR: Respiratory rate; HR: Heart Rate; MAP: Mean arterial pressure; OT: Oxygen therapy; PICU:
Pediatric care unit; ICU: Intensive care unit; PAP: Positive airway pressure; LFNC: Low-ow nasal cannula; CPB: Cardiopulmonary
bypass; HLOS: Length of hospital stay.
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DISCUSSION
The hemodynamic effects reported in the studies show signicant outcomes, such as
improvement in PaO2 and decreased PCO2, when related to the use of HFNC with other therapeutic
modalities in pediatric patients in the postoperative period. In addition, with regard to clinical
outcomes, most of the studies analyzed point to a reduction in reintubation rates among patients
who received HFNC, demonstrating promising results in relation to conventional oxygen therapy and
noninvasive ventilation (NIV). This therapeutic strategy was also associated with a decrease in the
length of stay of cardiac patients in pediatric intensive care units (PICUs).
PaO2 has been widely discussed among authors. One study evaluated the efcacy and safety
of HFNC compared with conventional oxygen therapy, using beroptic bronchoscopy to examine the
inside of the airway. During this procedure, it was observed that the variable called transcutaneous
oxygen tension (TcPaO2) was higher with the use of HFNC than with conventional oxygen therapy.
At the same time, PaO2 values remained similar at the beginning of another study, however, when
compared between the groups submitted to HFNC and oxygen therapy, it was found that the HFNC
group presented higher values after extubation (Zheng; Chen; Zhou, 2023) 10. Concomitantly, two
studies identied that there was no difference in PaO2 levels in the comparison between HFNC and
NIV, assessed 24 hours after the use of the therapies ( Jayashankar et al., 2020; Kumar et al.,
2022) . Additionally, two studies have highlighted the PaO2/FiO2 ratio as an important indicator of gas
exchange efciency. The results indicated that, after extubation, the group that used HFNC presented
higher values at all times evaluated. One of the studies detailed that these values were highest at 6,
12, 24 and 36 hours after extubation. ( Enayati et al., 2021; Testa et al., 2014) ( Enayati et
al., 2021)
PCO2 was similar between the groups that used HFNC, NIV and oxygen therapy, with no
statistically signicant differences, as evidenced in the studies. A meta-analysis with three studies
demonstrated that, when assessing PCO (Itagaki et al., 2019; Testa et al., 2014) 24 hours after the
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use of HFNC and NIV, the groups also did not show a reduction in the levels of this variable (
Jayashankar et al., 2020; Kumar et al., 2022; Shioji et al., 2019) . In addition, carbon dioxide
tension was analyzed in the HFNC and oxygen therapy groups, and was lower in patients who used
HFNC during the examination. In turn, a specic study demonstrated that PCO2 was lower in the
HFNC group after extubation, indicating a more efcient elimination of retained CO2. This difference
was observed at 6, 24 and 36 hours post-extubation, with no signicant variation before the procedure.
(Zheng; Chen; Zhou, 2023) ( Enayati et al., 2021)
With regard to RF, only two studies made these data available. One of them indicated that
there was no difference between the groups evaluated with another therapeutic modality, while the
other showed a reduction in RF in the HFNC group, especially when using a rate adjusted in liters
per kilogram per minute (L/kg/min). Regarding SpO2, HR and BP, only one study evaluated these
clinical outcomes, nding only improvement in saturation and no differences were identied between
the other variables analyzed before and after the test. The duration of cardiopulmonary bypass did not
present signicant differences between the HFNC group and the control group. Similarly, in studies
that compared HFNC with NIV, no differences were observed in this variable between the groups,
with a value of p = 0.07. (Itagaki et al., 2019; Zheng; Chen; Zhou, 2023) (Zheng; Chen; Zhou, 2023)
( Enayati et al., 2021) ( Beshish et al., 2023; Jayashankar et al., 2020; Kumar et al., 2022)
Another point highlighted is that there was no failure in the treatment with the use of HFNC,
while in the group submitted to conventional oxygen therapy, failure was observed for reasons such as
respiratory or cardiac complications, thus requiring non-invasive respiratory support. In addition, the
incidence of respiratory failure decreased in both the HFNC and control groups, in the period before
surgery and after in the ICU. When analyzing the rates of postoperative atelectasis in patients who
used HFNC or not, a slight reduction was observed among those who used it. The rate of extubation
failure did not differ signicantly between the groups that used support due to indication of respiratory
failure, shock, cardiac arrest, and altered mental status within a period of up to 48 hours. (Testa et al.,
2014) ( Enayati et al., 2021) ( Öztürk et al., 2024) (Richter et al., 2019)
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The reintubation rate and length of stay in the pediatric and neonatal intensive care unit
(PICU) were clinical variables evaluated. There was a reduction in both outcomes, which is a positive
point in the use of HFNC, and the main difference between the studies corresponds to the data collected
and the time each author performed this assessment. Among the studies that analyzed these variables,
only one did not identify a signicant difference in the reintubation rate and length of stay in the
PICU among patients who used HFNC in the postoperative period of cardiac surgeries. Corroborating
these outcomes, four studies included in a systematic review with meta-analysis assessed the rate of
reintubation and three assessed the length of ICU stay comparing the effects of HFNC and NIV. A
reduction in the rate of reintubation and hospitalization of these children was observed, presenting
a P<0.05, despite the heterogeneity between the studies analyzed. The literature also presents the
impacts between therapies in the pediatric hospital setting, a clinical trial with 121 children compared
the efcacy of HFNC and NIV-PP in the length of hospital stay, and the mean difference observed
did not indicate changes, demonstrating similar performance between both interventions. Thus, it
is possible to observe that, in relation to these aspects, there is evidence described in the current
literature. ( Enayati et al., 2021; Öztürk et al., 2024; Richter et al., 2019) (Testa et al.,
2014) ( Beshish et al., 2023; Jayashankar et al., 2020; Kumar et al., 2022; Shioji et al.,
2019) ( Beshish et al., 2023; Kumar et al., 2022; Shioji et al., 2019) (Kumar et al., 2022)
Although there are publications, this topic is little discussed, which limits the strength of
the evidence. In addition, some studies present heterogeneity in the sample analyzed, did not specify
the age range of the children included, which makes it difcult to evaluate and possibly inuence on
which ages beneted most from the use of HFNC in the postoperative period of cardiac surgeries
depending on the type of surgery, heart disease, pulmonary and systemic hemodynamics in the pre-
and postoperative periods, variables that may have improved after surgery, since the ow of liters
per minute in the use of HFNC is calculated based on the child’s age or weight, adapting to the
particularity of each patient.
This study has as a limitation the lack of evaluation of the methodological quality of the
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included articles, which may have compromised the robustness of the evidence, which needs a critical
and rigorous analysis, requiring greater caution in the interpretation of the data. In addition, as this
is a scoping review, there is considerable variability in the types of studies and methods used, which
can make it difcult to categorize, systematize and interpret the results obtained. In addition, another
limitation is the absence of attempts to contact the authors to verify the availability of the articles,
which may have resulted in the exclusion of relevant publications available from other sources.
Thus, further studies are needed to ll the existing gaps and accurately describe the effects
of HFNC, as well as its potential benets compared to other therapeutic modalities, considering the
limitations and imprecision of the available data on the subject.
CONCLUSION
The ndings of this study indicate a tendency for the analyzed therapy to contribute to the
improvement of PaO2, PCO2, reintubation rate and reduction in hospital stay in the postoperative period
of pediatric cardiac surgery. However, the results referring to SpO2, RF, HR, BP, CPB, atelectasis rate,
and treatment failure did not show relevant changes in most of the studies evaluated.
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