Abstract
This retrospective, observational cohort study aimed to determine the independent risk factors and impact of prolonged non-invasive positive pressure ventilation (NIPPV) after extubation among patients in the intensive care unit following cardiac surgery. Patients who received prophylactic NIPPV after extubation were categorized into prolonged (NIPPV duration >3 days, n = 83) and non-prolonged groups (NIPPV duration ≤3 days, n = 105). The perioperative characteristics and hospital outcomes were recorded. The multivariate analyses identified the preoperative residual volume/total lung capacity (RV/TLC) ratio (adjusted odds ratio [AOR]: 1.10; 95% CI:1.01–1.19, p = 0.022) and postoperative acute kidney injury (AKI) with Kidney Disease Improving Global Outcomes (KDIGO) stage 2–3, 48 h after surgery (AOR: 3.87; 95% CI:1.21–12.37, p = 0.023) as independent predictors of prolonged NIPPV. Patients with both RV/TLC ratio > 46.5% and KDIGO stage 2–3 showed a highly increased risk of prolonged NIPPV (HR 27.17, p = 0.010), which was in turn associated with higher risk of postoperative complications and prolonged ICU and hospital stays. Preoperative RV/TLC ratio and postoperative AKI could identify patients at higher risk for prolonged NIPPV associated with poor outcomes. These findings may allow early recognition of patients who are at a higher risk for prolonged NIPPV, and help refine the perioperative management and critical care.
Highlights
Noninvasive positive pressure ventilation (NIPPV) has primarily been applied in patients with acute exacerbation of chronic obstructive pulmonary disease, worsening asthma and exacerbation, cardiogenic pulmonary edema, and hypoxemic acute respiratory failure (ARF)[1,2,3]
Our study reported that the preoperative residual volume/ total lung capacity (RV/total lung capacity (TLC)) ratio and acute kidney injury (AKI) of Kidney Disease Improving Global Outcomes (KDIGO) Stage 2–3 within 48 h postoperatively were independent predictive factors for prolonged non-invasive positive pressure ventilation (NIPPV) after extubation among patients in the ICU following cardiac surgery
We suggest that an residual volume (RV)/TLC ratio cut-off value of greater than 46.5% and AKI of KIDGO Stage 2–3 can be used by intensivists to preoperatively and postoperatively identify patients who are at a high risk of prolonged NIPPV after cardiac surgery
Summary
Noninvasive positive pressure ventilation (NIPPV) has primarily been applied in patients with acute exacerbation of chronic obstructive pulmonary disease, worsening asthma and exacerbation, cardiogenic pulmonary edema, and hypoxemic acute respiratory failure (ARF)[1,2,3]. Mortality, and the development of postoperative complications are determined by several perioperative factors in patients undergoing cardiac surgery[17,18]. Prolonged NIPPV after cardiac surgery could be a result of postoperative complications associated with cardiac and pulmonary dysfunctions[19], prolonged NIPPV potentially contributes to respiratory complications (e.g., pneumonia and respiratory muscle weakness) and subsequently worsens patient outcomes[19,20]. There is no study examining the relationship between prolonged NIPPV and patient outcomes including postoperative complications, morbidity, and mortality. This study aimed to investigate the independent risk factors for prolonged NIPPV after extubation among patients in the ICU following cardiac surgery and determine the impact of prolonged NIPPV on patient outcomes
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