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Is the high‐flow nasal oxygen the only affecting parameter on hospital length of stay?

Last post 12 Nov 2018, 8:23 AM by Ozkan Onal. 0 replies.
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  •  12 Nov 2018, 8:23 AM 2687

    Is the high‐flow nasal oxygen the only affecting parameter on hospital length of stay?

    Zochios et al. found that, when compared with standard care, prophylactic postoperative high-flow nasal oxygen reduced hospital length of stay and intensive care unit re-admission [1]. We invite the authors to reply to some comments that we have about their paper.

    Firstly, the study was performed in patients undergoing cardiac surgery with pre-existing pulmonary disease, or who were heavy smokers or morbidly obese, and therefore might be expected to stay in intensive care and in hospital longer postoperatively, due to the possibility of respiratory complications. However, we challenge the authors' attribution of the difference between the two groups in terms of length of stay in the hospital being due to respiratory complications, without their having investigated these reasons in detail [2]. The duration of long hospital stay (> 10 days) could have been related to variables such as age, gender, elective/emergency surgery, angina class, ejection fraction, operation type and duration [3], and blood transfusion [4]. Do the authors think that any of these variables may have affected their results?

    Secondly, patients in the low-oxygen group may have had specific cardiac mortality predisposing them to prolonged hospitalisation, such as diastolic dysfunction [5] and coronary artery disease pattern [6]. Can the authors publish any information confirming the study groups were similar for these parameters?


    O. Onal

    M. Sari

    H. H. Bayram

    Selcuk University Medical Faculty,

    Konya, Turkey.

    Email: drozkanonal@selcuk.edu.tr


    No external funding and no conflicts of interest declared.


    1. Zochios V, Collier T, Blaudszun G, Butchart A, Earwaker M, Jones N, Klein AA. The effect of high-flow nasal oxygen on hospital length of stay in cardiac surgical patients at high risk for respiratory complications: a randomised controlled trial. Anaesthesia 2018; 73: 1478-88.

    2. Oliveira EK, Silva VZ, Turquetto AL. Relationship on walk test and pulmonary function tests with the length of hospitalization in cardiac surgery patients.  Revista Brasileira de Cirurgia Cardiovascular 2009; 24: 478-84.

    3. Weintraub WS, Jones EL, Craver J, Guyton R, Cohen C. Determinants of prolonged length of hospital stay after coronary bypass surgery. Circulation 1989 ; 80: 276-84.

    4. Galas FR, Almeida JP, Fukushima JT, Osawa EA, Nakamura RE, Silva CM, de Almeida EP, et al. Blood transfusion in cardiac surgery is a risk factor for increased hospital length of stay in adult patients. Journal of Cardiothoracic Surgery 2013; 8: 54.

    5. Metkus TS, Suarez-Pierre A, Crawford TC, Lawton JS, Goeddel L, Dodd-O J, Mukherjee M, et. al. Diastolic dysfunction is common and predicts outcome after cardiac surgery. Journal of Cardiothoracic Surgery 2018; 13: 67.

    6. Mounsey JP, Griffith MJ, Heaviside DW, Brown AH, Reid DS. Determinants of the length of stay in intensive care and in hospital after coronary artery surgery. British Heart Journal 1995; 73: 92-8.

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