Oxygenation failure after cardiac surgery: early re-intubation versus treatment by nasal continuous positive airway pressure (NCPAP) or non-invasive positive pressure ventilation (NPPV)

https://doi.org/10.4081/monaldi.2008.425

Authors

  • Muhammed Kurt Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital, Duesseldorf, Germany.
  • Udo Boeken Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital, Duesseldorf, Germany.
  • Jens Litmathe | litmathe@med.uni-duesseldorf.de Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital, Duesseldorf, Germany.
  • Peter Feindt Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital, Duesseldorf, Germany.
  • Emmeran Gams Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Hospital, Duesseldorf, Germany.

Abstract

Background: Due to an increasing incidence of respiratory failure after cardiac surgery we wanted to study whether nasal continuous positive airway pressure (NCPAP) may improve pulmonary oxygen transfer and may avoid reintubation after coronary operations. Additionally, we compared this protocol to non-invasive positive pressure ventilation (NPPV). Methods: For a period of 2 years we analyzed all patients that were extubated within 12 hours after coronary surgery, and in whom oxygen transfer (PaO2/FIO2) deteriorated without hypercapnia so that all these patients met predefined criteria for reintubation: group A=immediate reintubation (n=88), group B=NCPAP-treatment (n=173), group C=NPPV(n=18). Results: 25,4% of group B- and 22,2% of group C-patients were also intubated after a period of NCPAP or NPPV. All other patients of groups B and C could be weaned from these devices (B = 34.3 ± 5.9 hours; C = 26.4 ± 4.4 h; p<0.05) and were well oxygenated by face mask at ambient pressure (Ratio PaO2/FIO2: B, 138 ± 13; C, 140 ± 13). In group A we found a higher mortality (7.95%) compared to group B (4.04%) and group C (5.55%). NCPAP-patients suffered more frequently from an impaired sternal wound healing (A = 4.5%, B = 8.6%; p<0.05). Conclusions: We conclude that reintubation after cardiac operations should be avoided since NCPAP and NPPV are safe and effective to improve arterial oxygenation in most patients with non hypercapnic respiratory failure.

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Published
2016-01-26
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Section
Original Articles
Keywords:
cardiac surgery, respiratory failure, reintubation, non-invasive positive pressure ventilation (NPPV), nasal continuous positive airway pressure (NCPAP)
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How to Cite
Kurt, Muhammed, Udo Boeken, Jens Litmathe, Peter Feindt, and Emmeran Gams. 2016. “Oxygenation Failure After Cardiac Surgery: Early Re-Intubation Versus Treatment by Nasal Continuous Positive Airway Pressure (NCPAP) or Non-Invasive Positive Pressure Ventilation (NPPV)”. Monaldi Archives for Chest Disease 70 (2). https://doi.org/10.4081/monaldi.2008.425.

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