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Royal Papworth Hospital to lead £1.4m study on delivering high-flow oxygen to patients after cardiac surgery




A study on delivering high-flow oxygen to patients through their nose after cardiac surgery will be led by the Royal Papworth Hospital after £1.4million of funding was awarded.

The grant, from the National Institute for Health Research (NIHR). will fund a study in 10 cardiac surgery centres in the UK involving almost 1,000 patients.

Clockwise from top left, consultant anaesthetist Professor Andrew Klein, clinical project manager Melissa Duckworth, Pooveshni Govender, a research fellow in the Department of Anaesthesia and Intensive Care, NOTACS trial manager Melissa Earwaker and trial statistician Yi-Da Chiu with a high-flow machine. (27768184)
Clockwise from top left, consultant anaesthetist Professor Andrew Klein, clinical project manager Melissa Duckworth, Pooveshni Govender, a research fellow in the Department of Anaesthesia and Intensive Care, NOTACS trial manager Melissa Earwaker and trial statistician Yi-Da Chiu with a high-flow machine. (27768184)

It follows a pilot study three years ago involving 100 patients at Papworth, which found that they were discharged more quickly from hospital and readmitted less frequently to intensive care after cardiac surgery if given the nasal oxygen.

Professor Andrew Klein, consultant anaesthetist at Royal Papworth Hospital on Cambridge Biomedical Campus, said: “When cardiac patients have an operation, which involves opening up their chest wall, it can be painful to breathe deeply for a short time afterwards.

“If a patient has a pre-existing lung disease like asthma then this becomes even more difficult.

“The high-flow device allows the lungs to inflate more fully and re-expand because a larger volume of air is being forced into the lungs – up to 60 litres per minute. This quantity has been chosen because other studies analysing high-flow have shown that 50-60 litres is the optimum amount.

“This not only allows a patient to breathe more deeply but also reduces infection and is more comfortable for patients because the air is humidified and warmed to 40 degrees Celsius. The key thing here is that we are not increasing the concentration of the oxygen, just the flow.”

Some of the patients who have tried it have been involved in designing the Nasal High-flow Oxygen Therapy after Cardiac Surgery (NOTACS) study.

Among them was asthma sufferer Geoff Brown, 72, from Peterborough, who had a triple heart bypass in February 2016 and was placed on high-flow for the first 22 hours after his operation.

He said: “I went into the anaesthetic room for my operation at 4.30pm on a Tuesday. By 10am the following day I had been moved from critical care to a general ward and on the Saturday afternoon, I was discharged back home.

“I thought I’d be in hospital for at least a week, so to be out within four days was amazing and I felt very good throughout my whole recovery.

“I’m now part of the committee that has been involved in conference calls, meetings and written correspondence to take this study to the next phase. It’s a fascinating subject and if it helps others to recover like I did then it can only be a good thing.”

Geoff’s wife Val added: “We had said we were interested when asked about high-flow at the pre-operation meeting but there was no guarantee it would be used for Geoff's treatment. We found out it had been used about 18 months after Geoff’s operation when we were invited to take the study further.

“It was amazing seeing Geoff in hospital just after his operation. I went along with our youngest son on the Wednesday lunchtime to see him. It hadn’t yet been 24 hours but he was already sitting up and talking, breathing incredibly well and he had no shortage of breath at all. We joked about whether he had actually had the operation!”

Melissa Earwaker, trial manager for the study, said the initial study showed a patient’s stay decreased by a third, improving their recovery and safety.

“Additionally, it helps to free up bed space in both critical care and on the wards, therefore saving the trust money and allowing us to treat more patients,” she said.

“This larger study will be run by the Royal Papworth clinical trials unit for the next three years and will begin in spring 2020.”

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