Postoperative Respiratory Failure After Cardiac Surgery: Use of Noninvasive Ventilation

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• 作者：Manuel Garc&iacute ; a-Delgado ; MD ; ^{mjgardel@telefonica.net} ; In&eacute ; s Navarrete ; MD ; Maria Jos&eacute ; Garc&iacute ; a-Palma ; MD ; Manuel Colmenero ; MD
• 关键词：acute respiratory failure ; cardiac surgery procedures ; noninvasive ventilation ; postoperative ; reintubation
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2012
• 期刊代码：163_10530770
• 类别：med
• 出版时间：June, 2012
• 卷：26
• 期：3
• 页码：443-447
• 文件大小：283 K

摘要

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Objectives

To analyze the use of noninvasive ventilation (NIV) in respiratory failure after extubation in patients after cardiac surgery, the factors associated with respiratory failure, and the need for reintubation.

Design

Retrospective observational study.

Setting

Intensive care unit in a university hospital.

Participants

Patients (n = 63) with respiratory failure after extubation after cardiac surgery over a 3-year period.

Interventions

Mechanical NIV.

Measurements and Main Results

Demographic and surgical data, respiratory history, causes of postoperative respiratory failure, durations of mechanical ventilation and spontaneous breathing, gas exchange values, and the mortality rate were recorded. Of 1,225 postsurgical patients, 63 (5.1%) underwent NIV for respiratory failure after extubation. The median time from extubation to the NIV application was 40 hours (18-96 hours). The most frequent cause of respiratory failure was lobar atelectasis (25.4%). The NIV failed in 52.4%of patients (33/63) who had a lower pH at 24 hours of treatment (7.35 v 7.42, p = 0.001) and a higher hospital mortality (51.5%v 6.7%, p = 0.001) than those in whom NIV was successful. An interval <24 hours from extubation to NIV was a predictive factor for NIV failure (odds ratio, 4.6; 95%confidence interval, 1.2-17.9), whereas obesity was associated with NIV success (odds ratio, 0.22; 95%confidence interval, 0.05-0.91).

Conclusions

Reintubation was required in half of the NIV-treated patients and was associated with an increased hospital mortality rate. Early respiratory failure after extubation (鈮?4 hours) is a predictive factor for NIV failure.