Noninvasive Mechanical Ventilation in Patients with Acute Respiratory Failure after Cardiac Surgery
DOI:
https://doi.org/10.1532/HSF98.20091116Abstract
Objective: To evaluate the feasibility and outcomes of protocol-driven noninvasive mechanical ventilation in patients with acute respiratory failure (ARF) after cardiac surgery.
Methods: From 2001 to 2004, a total of 2428 cardiac surgery patients admitted to our intensive care unit were observed. After exclusion of patients who received tracheostomy or were discharged while still on mechanical ventilation, 2261 patients with spontaneous breathing were further evaluated for ARF. Patients diagnosed with ARF were treated with intermittent noninvasive mechanical ventilation (NIV) if possible. Risk factors for the development of postoperative ARF as well as outcomes in patients with and without ARF were analyzed.
Results: In 2261 spontaneously breathing postoperative cardiac surgical patients after primarily successful extubation, 799 patients (35%) were diagnosed with ARF. Fifty-six patients (7%) did not tolerate NIV treatment. In 743 patients (33%) intermittent NIV was performed. In patients with ARF, ejection fraction was lower, combined cardiac surgical procedures were more frequent, postoperative mechanical ventilation time was longer, and the severity of illness score (SAPS II) was higher (P < .05). The duration of catecholamine support was longer, and the transfusion rate was higher in the NIV group (P < .05); however, mortality did not differ between patients with ARF treated by NIV and patients without ARF.
Conclusion: Our study demonstrates the feasibility of NIV in patients after cardiac surgery. These results might suggest that NIV should be considered as first-line ventilatory support in ARF after cardiac surgery. A large randomized trial is warranted to confirm these findings.
References
Bando K, Sun K, Binford RS, Sharp TG. 1997. Determinants of longer duration of endotracheal intubation after adult cardiac operations. Ann Thorac Surg 63:1026-33.nBingol H, Cingoz F, Balkan A, et al. 2005. The effect of oral prednisolone with chronic obstructive pulmonary disease undergoing coronary artery bypass surgery. J Card Surg 20:252-6.nCanver CC, Chanda J. 2003. Intraoperative and postoperative risk factors for respiratory failure after coronary bypass. Ann Thorac Surg 75:853-7.nCelebi S, Köner Ö, Menda F, et al. 2008. Pulmonary effects of noninvasive ventilation combined with the recruitment maneuver after cardiac surgery. Anesth Analg 107:614-9.nDe Santo LS, Bancone C, Santarpino G, et al. 2009. Noninvasive positive-pressure ventilation for extubation failure after cardiac surgery: pilot safety evaluation. J Thorac Cardiovasc Surg 137:342-6.nEpstein SK. Extubation failure. 2000. In: Vincent JL, Ed. Yearbook of intensive care and emergency medicine. New York: Springer: 305-17.nKern H, Kox WJ. 1999. Impact of standard procedures and clinical standards on cost-effectiveness and intensive care unit performance in adult patients after cardiac surgery. Intensive Care Med 25:1367-73.nKern H, Redlich U, Hotz H, et al. 2001. Risk factors for prolonged ventilation after cardiac surgery using APACHE II, SAPS II, and TISS: comparison of three different models. Intensive Care Med 27:407-15.nKilger E, Briegel J, Haller M, et al. 1999. Effects of noninvasive positive pressure ventilatory support in non-COPD patients with acute respiratory insufficiency after early extubation. Intensive Care Med 25:1374-80.nKindgen-Milles D, Buhl R, Loer SA, Müller E. 2002. Nasal CPAP therapy: effects of different CPAP levels on pressure transmission into the trachea and pulmonary oxygen transfer. Acta Anaesthesiol Scand 46:860-5.nLe Gall JR, Lemeshow S, Saulnier F. 1993. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957-63.nLightowler JV, Wedzicha JA, Elliott MW, Ram FS. 2003. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systemic review and meta-analysis. BMJ 326:185.nMartinez-Alario J, Tuesta ID, Plasencia E, Santana M, Mora ML. 1999. Mortality prediction in cardiac surgery patients: comparative performance of Parsonnet and general severity systems. Circulation 99:2378-82.nPasquina P, Merlani P, Granier JM, Ricou B. 2004. Continuous positive airway pressure versus noninvasive pressure support ventilation to treat atelectasis after cardiac surgery. Anesth Analg 99:1001-8.nRoques F, Nashef SA, Michel P, et al. 1999. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 15:816-22.nStaton GW, Williams WH, Mahoney EM, et al. 2005. Pulmonary outcomes of off-pump vs on-pump coronary artery bypass surgery in a randomized trial. Chest 127:892-901.n
