A device that helps patients to breathe more easily following major heart surgery that may boost their longer-term recovery and help cut complications is being studied at Royal Papworth Hospital.
The device, worn in a patient’s nose, provides a specially-adapted mix of warm, moist air with extra oxygen – known as nasal high-flow therapy – in the crucial 24 hours following their operation. Patients find the device more comfortable to use than standard oxygen therapy delivered through a face mask.
Recovering from heart surgery can be challenging and painful.
This is a difficult time for patients. Inflating their lungs with this new device can help them breath more deeply and may help to stop them from developing chest infections and other complications.
Dr Andrew Klein, Consultant anaesthetist at Royal Papworth Hospital NHS Foundation Trust and lead investigator in a study to assess the device.
Up to 10,000 patients a year in the UK could benefit from the device if it is found to be effective. Changing post-surgery care could boost the longer-term recovery in these patients who often suffer complications due to other pre-existing conditions, such as chronic lung disease.
“The question is does nasal high flow therapy work? And does it have an impact on patients after they go home?” asks Dr Klein.
The study – led by Royal Papworth and funded by the National Institute for Health and Care Research in the UK– is recruiting 1,200 patients from 19 centres in the UK, Australia, and New Zealand. Results are expected next year.
Following their heart surgery, patients are given the nasal high-flow therapy for 24 hours and then followed-up 90 days’ later with a detailed telephone interview. They are compared with patients who receive standard oxygen therapy through a facemask or nasal prongs.
Of particular interest is how well patients recovered after surgery, as measured by the number of days that they have been able to spend at home without additional help.
We want to see what a patient’s life has been like up to that point in time and understand the more detailed aspects, such as whether they’ve had to move into a residential home or get a carer in. Or maybe they’ve had to get new drugs prescribed.
Dr Andrew Klein
“These are very sensitive outcomes that have not been used in this sort of study before,” says Dr Klein.
In addition, the study is looking into whether nasal high flow therapy is cost effective. Will the costs – including buying the devices, staff training and time, and drugs – outweigh the benefits of speeding up patient recovery, such as freeing up hospital beds, and enabling more patients to have surgery.
Preliminary results have been positive with patients saying they liked using the device, and an early indication that it had improved their quality of life after leaving hospital.
Research trials like this take time and money. Dr Klein estimates that it has taken 10 years of time and several million pounds of funding to get the research to this point. He also stresses the importance of patient involvement at every stage during the study design: “It was designed by patients for patients. They decided how best to ask the interview questions, film information videos, and make everything as understandable as possible,” says Dr Klein.
He continues: “Research is all about making health care safer and more effective so that patients have a better recovery. We need to partner with patients to look at what works, and which questions we need to answer.”
“Those patients who take part are helping others with the same condition to have a better recovery in years to come,” he concludes.
If successful, other groups of patients such as those having abdominal surgery, may also be included in future research into this treatment.
For more information about the NOTACS trial see Research project summaries :: Royal Papworth Hospital (opens in a new tab)