Noninvasive ventilation outside the intensive care unit for respiratory rehabilitation after on-pump cardiac surgery: a prospective randomized controlled trial

Abstract

BACKGROUND: Сardiac surgery with cardiopulmonary bypass is associated with a high risk of postoperative respiratory complications. Perioperative damage to the lungs caused by ischemia and reperfusion, mechanical ventilation, trauma, etc., is a trigger for aseptic inflammation in the lungs, and it makes compromised lungs an easy target for infection. Actively developed methods of protecting the lungs, such as lung-protective ventilation, are limited to the perioperative and resuscitation stages and do not exhaust the entire range of respiratory support required in the later stages of postoperative hospitalization. This indicates the need for methods of respiratory rehabilitation following transfer from the intensive care unit. AIM: To evaluate the effectiveness of respiratory rehabilitation using noninvasive mask lung ventilation performed outside the intensive care unit in cardiosurgical patients compared to standard breathing exercises. MATERIALS AND METHODS: This prospective, randomized, single-center study included 60 patients aged 62±12 years who underwent cardiac surgery with cardiopulmonary bypass (86±17 min) with bypass grafting of 2±1 coronary arteries and required mechanical lung ventilation for more than 6 hours following surgery. After transfer from the intensive care unit, patients in the control group (n=30) underwent standard respiratory rehabilitation, and those in the main group (n=30) additionally received four sessions of noninvasive mask lung ventilation. RESULTS: The patients in the main group had a more rapid respiratory function recovery and, thus, reduced postoperative hospitalization time (10 [8; 15]) compared to those in the standard group (14 [13; 20]). CONCLUSION: The use of noninvasive mask lung ventilation outside the intensive care unit along with the standard respiratory activation protocol is safe and speeds up respiratory rehabilitation and reduces postoperative hospitalization of patients after coronary bypass surgery.