[The perioperative role of high-flow cannula oxygen (HFNO)]. / Place de l'oxygénothérapie nasale à haut débit en périopératoire.

High-flow nasal cannula oxygen (HFNO) is commonly used during the perioperative period. Its numerous physiological benefits, satisfactory tolerance and ease of use have led to its widespread application in intensive care and post-anesthesia care units. HFNO is also used in the operating theater in multiple indications: as oxygen supplementation (associated with pressurization) prior to orotracheal intubation; in digestive and bronchial endoscopies, especially in patients at risk of hypoxemia; and in intraoperative surgery requiring spontaneous ventilation (ENT, thoracic surgery…). During the postoperative period, HFNO can be used in a curative strategy for respiratory failure or in a prophylactic strategy to prevent reintubation. In a curative approach, HFNO seems of interest following cardiac or thoracic surgery but has not been evaluated in respiratory failure subsequent to abdominal surgery, in which case noninvasive ventilation remains the gold standard. The risk of respiratory complications depends on type of surgery and on patient comorbidities. As prophylaxis, HFNO is currently preferred to conventional oxygen therapy after cardiac or thoracic surgery, especially in patients at high risk of respiratory complications. For the clinician, it is important to acknowledge the limits of HFNO and to closely monitor patients receiving HFNO, the objective being to avoid delays in intubation that could lead to increased mortality.

Influence of pain on postoperative ventilatory disturbances. Management and expected benefits.

Abdominal surgery induces postoperative ventilatory dysfunction related to a combination of reflex diaphragmatic inhibition, respiratory muscle injury and pain. The role of pain is difficult to isolate from other components. Thoracic epidural analgesia using local anesthetics is able to partially reverse the diaphragmatic dysfunction. However, this effect seems not directly related to analgesia. Regardless of the mechanisms, epidural analgesia has been shown to improve the postoperative ventilation and to prevent the occurrence of pulmonary complications. Pain relief, either by parenteral administration of opiate, and/or parietal blockade has been shown to improve the diaphragm motion and the overall respiratory status. All analgesic strategies may facilitate the implementation of postoperative physiotherapy which has a significant interest in preventing postoperative pulmonary complications.