High-flow nasal cannula in a patient with prolonged air leak following cardiothoracic surgery: A case-based observation.

Prolonged air leak (PAL) following cardiothoracic surgery severely limits available ventilatory strategies. We report a 68-year-old male who developed bilateral PAL after coronary artery bypass grafting and mitral valve replacement. Despite maximal ventilatory support, critical hypoxaemia persisted. Following early extubation at hour 72, high-flow nasal cannula (HFNC) was initiated, achieving rapid oxygenation recovery (ΔPaO2 +22 mmHg, ΔPaCO2 -15 mmHg within 24 hours). Combined with awake physiotherapy and intermittent noninvasive ventilation, HFNC facilitated clinical recovery without re-intubation. This case illustrates HFNC as a feasible respiratory support alternative when positive-pressure strategies are limited by PAL.