Abstract
Noninvasive positive pressure ventilation (NPPV) has been applied to various types of respiratory failure. However, perioperative application of NPPV is still controversial. In addition, there are very limited reports regarding NPPV after cardiovascular surgery. Therefore, we retrospectively surveyed the reason and outcome of NPPV in patients after cardiovascular surgery. We divided 53 patients, who developed post-extubation acute respiratory failure after cardiovascular surgery, into 2 groups: group S, in which re-intubation was prevented, and group F, in which re-intubation was needed. We compared patients' profile, operative data, preceding mechanical ventilation, initial settings of NPPV, and respiratory and hemodynamic parameters before and after starting NPPV. Twenty-three patients needed re-intubation, while 30 patients did not. Group F had larger operative bleeding, larger transfusion and longer mechanical ventilation than group S. In group S, after starting NPPV, respiratory rate and PaCO2 decreased, while PaO2 increased. In contrast, in group F, the decreases in respiratory rate and PaCO2 were small and PaO2 did not increase. During NPPV, group S showed lower PaCO2 and higher P/F ratio than group F. In group S, after starting NPPV, heart rate decreased and mixed venous oxygen saturation increased, although the changes were not significant in group F. Length of ICU stay was longer in group F than group S, but hospital day was not different between the groups. In conclusion, NPPV seemed to be useful in post-extubation acute respiratory failure in patients after cardiovascular surgery. In the group S in which re-intubation was not needed, respiratory and hemodynamic parameters improved in a short time.
