Abstract
BackgroundIt remains to be clarified if the application of noninvasive positive pressure ventilation (NPPV) is effective after extubation in patients with hypoxemic respiratory failure who require the sufficient level of positive end-expiratory pressure (PEEP). This study was aimed at examining the effect and the safety of NPPV application following extubation in patients requiring moderate PEEP level for sufficient oxygenation after cardiovascular surgery.MethodsWith institutional ethic committee approval, the patients ventilated invasively for over 48 h after cardiovascular surgery were enrolled in this study. The patients who failed the first spontaneous breathing trial (SBT) at 5 cmH2O of PEEP, but passed the second SBT at 8 cmH2O of PEEP, received NPPV immediately after extubation following our weaning protocol. Respiratory parameters (partial pressure of arterial oxygen tension to inspiratory oxygen fraction ratio: P/F ratio, respiratory ratio, and partial pressure of arterial carbon dioxide: PaCO2) 2 h after extubation were evaluated with those just before extubation as the primary outcome. The rate of re-intubation, the frequency of respiratory failure and intolerance of NPPV, the duration of NPPV, and the length of intensive care unit (ICU) stay were also recorded.ResultsWhile 51 postcardiovascular surgery patients were screened, 6 patients who met the criteria received NPPV after extubation. P/F ratio was increased significantly after extubation compared with that before extubation (325 ± 85 versus 245 ± 55 mmHg, p < 0.05). The other respiratory parameters did not change significantly. Re-intubation, respiratory failure, and intolerance of NPPV never occurred. The duration of NPPV and the length of ICU stay were 2.7 ± 0.7 (SD) and 7.5 (6 to 10) (interquartile range) days, respectively.ConclusionsWhile further investigation should be warranted, NPPV could be applied effectively and safely after extubation in patients requiring the moderate PEEP level after cardiovascular surgery.
Highlights
It remains to be clarified if the application of noninvasive positive pressure ventilation (NPPV) is effective after extubation in patients with hypoxemic respiratory failure who require the sufficient level of positive end-expiratory pressure (PEEP)
Ventilator setting was not changed for 2 h if O2 saturation monitored by pulse oximetry (SpO2) was maintained more than 92% and respiratory rate was less than 35 breaths/min
27 patients were weaned from invasive mechanical ventilation (IMV) within 48 h after surgery, whereas the rest were screened for the eligibility of this study
Summary
It remains to be clarified if the application of noninvasive positive pressure ventilation (NPPV) is effective after extubation in patients with hypoxemic respiratory failure who require the sufficient level of positive end-expiratory pressure (PEEP). Previous studies showed that noninvasive positive pressure ventilation (NPPV) is safe and effective to facilitate weaning from IMV in especially medical patients requiring long-term ventilatory support for predominantly hypercapnic respiratory failure [6,7,8]. Due to severe postoperative pulmonary complications such as atelectasis, pulmonary edema, pneumonia, and phrenic nerve palsy, postcardiovascular surgery patients often develop hypoxemic respiratory failure requiring high level of positive end-expiratory pressure (PEEP) for sufficient oxygenation and could suffer from prolonged IMV [9,10]. NPPV has been used widely for postoperative respiratory failure [11,12], there are few studies to examine whether NPPV can be applied effectively and safely after extubation in such population who requires sufficient PEEP level and longterm ventilator support after cardiovascular surgery
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