Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery. Noninvasive ventilatory support after lung resectional surgery. Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients. Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Noninvasive mechanical ventilation in patients with acute respiratory failure after cardiac surgery. Benefits of non-invasive ventilation after extubation in the postoperative period of heart surgery. Pulmonary Effects of Noninvasive Ventilation Combined with the Recruitment Maneuver After Cardiac Surgery Non-invasive pressure support ventilation in patients with acute respiratory failure after bilateral lung transplantation Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. Three different mask physiotherapy regimens for prevention of post-operative pulmonary complications after heart and pulmonary surgery Randomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques Human and financial costs of noninvasive mechanical ventilation in patients affected by COPD and acute respiratory failure. Prophylactic use of noninvasive ventilation in patients undergoing lung resectional surgery. Use of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery. Continuous positive airway pressure by mask in patients after coronary surgery Comparison of continuous positive airway pressure, incentive spirometry, and conservative therapy after cardiac operations Application of noninvasive ventilation in acute respiratory failure after cardiovascular surgery. Prophylactic use of noninvasive positive pressure ventilation in post-thoracic surgery patients: A prospective randomized control study.
STUDY OBJECTIVES Patients who undergo surgical repair of thoracoabdominal aortic aneurysms have a high risk for the development of respiratory complications , which cause significant postoperative morbidity and prolong hospitalization , compared to patients who undergo other types of surgery . We studied whether prophylactic noninvasive application of nasal continuous positive airway pressure ( nCPAP ) administered via a facemask immediately after extubation may reduce pulmonary morbidity and shorten the length of hospitalization . DESIGN Prospect i ve r and omized clinical trial . SETTING Surgical ICU of a university hospital . PATIENTS Fifty-six patients following elective prosthetic replacement of the thoracoabdominal aorta , of whom 6 patients were excluded because they had received prolonged mechanical ventilation . INTERVENTIONS Following extubation in the ICU , nCPAP was applied for 12 to 24 h at an airway pressure of 10 cm H2O to patients in the study group ( n = 25 ) . Subjects in the control group ( n = 25 ) received st and ard treatment including intermittent nCPAP ( 10 cm H2O for 10 min ) every 4 h. MEASUREMENTS AND RESULTS In the study group , nCPAP was applied for a mean ( + /- SD ) duration of 23 + /- 3 h at an airway pressure of 10 + /- 1 cm H2O , which improved pulmonary oxygen transfer without altering hemodynamics ( ie , heart rate , mean arterial BP , and central venous pressure ) . The application of nCPAP was associated with fewer pulmonary complications ( Pa(O2)/fraction of inspired oxygen [ F(IO2 ) ] < 100 , atelectasis , pneumonia , reintubation rate ) compared to the control group ( 7 of 25 patients vs 24 of 25 subjects , respectively ; p = 0.019 ) . The mean duration of intensive care treatment tended to be shorter in the study group compared to the control group ( 8 + /- 1 vs 12 + /- 2 days , respectively ; difference not significant ) , while the mean length of hospital stay was shorter with nCPAP therapy ( 22 + /- 2 vs 34 + /- 5 days , respectively ; p = 0.048 ) . CONCLUSIONS The prophylactic application of nCPAP at airway pressures of 10 cm H2O significantly reduced pulmonary morbidity and length of hospital stay following the surgical repair of thoracoabdominal aortic aneurysms . Thus , it can be recommended as a st and ard treatment procedure for this patient group STUDY OBJECTIVES To investigate the short-term effects of noninvasive ventilatory support ( NIVS ) on pulmonary gas exchange , ventilatory pattern , systemic hemodynamics , and pleural air leaks in patients su bmi tted to elective lung resection . DESIGN Prospect i ve , r and omized , parallel , and controlled investigation . SETTING Thoracic Surgery Unit , Hospital Universitari Son Dureta , Palma Mallorca , Spain . PATIENTS Nineteen patients electively su bmi tted to lung resection because of varied clinical reasons . INTERVENTIONS Medical therapy was st and ardized for all patients . Ten subjects received NIVS with a nasal ventilatory support system ( BiPAP ) during 1 h ( study group ) . The remaining nine individuals constituted the control group . MEASUREMENTS AND RESULTS Arterial blood gases , ventilatory pattern , systemic hemodynamics , and pleural air leaks were measured . Before surgery , there were no significant clinical or functional differences between groups . After surgery , and compared with preoperative measures , PaO2 decreased significantly ( p<0.01 ) and to the same extent both in the study group ( 85.7+/-2.8 to 68.0+/-2.7 mm Hg ) and the control group ( 83.6+/-2.5 to 67.3+/-2.6 mm Hg ) . In the study group , NIVS increased PaO2 ( to 76.7+/-3.0 mm Hg ; p<0.05 ) and decreased alveolar to arterial oxygen pressure gradient ( P[A-a]O2 ) ( 27.2+/-2.7 to 17.6+/-2.3 mm Hg ; p<0.05 ) . This latter effect was still present 1 h after withdrawing NIVS . By contrast , PaO2 and P(A-a)O2 remained unchanged in the control group throughout the study . PaCO2 , the ventilatory pattern , and systemic hemodynamics did not change significantly throughout the study in any group . Importantly , NIVS did not increase dead space to tidal volume ratio or worsen pleural air leaks . CONCLUSIONS Short-term NIVS with a ventilatory support system improves the efficiency of the lung as a gas exchanger without noticeable nondesired side effects in patients su bmi tted to lung resectional surgery BACKGROUND Continuous positive airway pressure is a noninvasive respiratory support technique that may prevent pulmonary complications following cardiac surgery . This study was conducted to determine the efficacy of prophylactic nasal continuous positive airway pressure ( nCPAP ) compared with st and ard treatment . The primary end points were pulmonary adverse effects defined as hypoxemia ( Pao(2)/fraction of inspired oxygen [ Fio(2 ) ] < 100 ) , pneumonia , and reintubation . The secondary end point was the readmission rate to the ICU or intermediate care unit ( IMCU ) . METHODS We prospect ively r and omized 500 patients scheduled for elective cardiac surgery . Following extubation either in the operating room ( early ) or in the ICU ( late ) , patients were allocated to st and ard treatment ( control ) including 10 min of intermittent nCPAP at 10 cm H(2)O every 4 h or prophylactic nCPAP ( study ) at an airway pressure of 10 cm H(2)O for at least 6 h. RESULTS Prophylactic nCPAP significantly improved arterial oxygenation ( Pao(2)/Fio(2 ) ) without altering heart rate and mean arterial BP . Pulmonary complications including hypoxemia ( defined as Pao(2)/Fio(2 ) < 100 ) , pneumonia , and reintubation rate were reduced in study patients compared to controls ( 12 of 232 patients vs 25 of 236 patients , respectively ; p = 0.03 ) . The readmission rate to the ICU or IMCU was significantly lower in nCPAP-treated patients ( 7 of 232 patients vs 14 of 236 patients , respectively ; p = 0.03 ) . CONCLUSIONS The long-term administration of prophylactic nCPAP following cardiac surgery improved arterial oxygenation , reduced the incidence of pulmonary complications including pneumonia and reintubation rate , and reduced readmission rate to the ICU or IMCU . Thus noninvasive respiratory support with nCPAP is a useful tool to reduce pulmonary morbidity following elective cardiac surgery When treated with invasive endotracheal mechanical ventilation ( ETMV ) , acute respiratory insufficiency after lung resection is fatal in up to 80 % of cases . Noninvasive positive-pressure ventilation ( NPPV ) may reduce the need for ETMV , thereby improving survival . We conducted a r and omized prospect i ve trial to compare st and ard therapy with and without nasal-mask NPPV in patients with acute hypoxemic respiratory insufficiency after lung resection . The primary outcome variable was the need for ETMV and the secondary outcome variables were in-hospital and 120-d mortality rates , duration of stay in the intensive care unit , and duration of in-hospital stay . Twelve of the 24 patients ( 50 % ) r and omly assigned to the no-NPPV group required ETMV , versus only five of the 24 patients ( 20.8 % ) in the NPPV group ( p = 0.035 ) . Nine patients in the no-NPPV group died ( 37.5 % ) , and three ( 12.5 % ) patients in the NPPV group died ( p = 0.045 ) . The other secondary outcomes were similar in the two groups . NPPV is safe and effective in reducing the need for ETMV and improving survival after lung resection OBJECTIVE To evaluate the feasibility and outcomes of protocol -driven noninvasive mechanical ventilation in patients with acute respiratory failure ( ARF ) after cardiac surgery . METHODS From 2001 to 2004 , a total of 2428 cardiac surgery patients admitted to our intensive care unit were observed . After exclusion of patients who received tracheostomy or were discharged while still on mechanical ventilation , 2261 patients with spontaneous breathing were further evaluated for ARF . Patients diagnosed with ARF were treated with intermittent noninvasive mechanical ventilation ( NIV ) if possible . Risk factors for the development of postoperative ARF as well as outcomes in patients with and without ARF were analyzed . RESULTS In 2261 spontaneously breathing postoperative cardiac surgical patients after primarily successful extubation , 799 patients ( 35 % ) were diagnosed with ARF . Fifty-six patients ( 7 % ) did not tolerate NIV treatment . In 743 patients ( 33 % ) intermittent NIV was performed . In patients with ARF , ejection fraction was lower , combined cardiac surgical procedures were more frequent , postoperative mechanical ventilation time was longer , and the severity of illness score ( SAPS II ) was higher ( P < .05 ) . The duration of catecholamine support was longer , and the transfusion rate was higher in the NIV group ( P < .05 ) ; however , mortality did not differ between patients with ARF treated by NIV and patients without ARF . CONCLUSION Our study demonstrates the feasibility of NIV in patients after cardiac surgery . These results might suggest that NIV should be considered as first-line ventilatory support in ARF after cardiac surgery . A large r and omized trial is warranted to confirm these findings OBJECTIVE to show the benefits of the use of non-invasive positive pressure ventilation ( NPPV ) in the process of weaning from mechanical ventilation in the immediate postoperative period of heart surgery . METHODS A prospect i ve , r and omized and controlled study was performed involving 100 consecutive patients su bmi tted to coronary artery bypass grafting or valve surgery . The subjects were admitted into the Intensive Care Unit ( ICU ) under mechanical ventilation and r and omized in a study group ( n=50 ) , which used NPPV with bilevel pressure for 30 minutes after extubation , and a control group ( n=50 ) which only used a nasal O2 catheter .  Anthropometric variables and the times of the intra-operative periods corresponding to anesthesia , surgery and cardiopulmonary bypass , as well as the time required for weaning from invasive mechanical ventilation were analysed . The arterial blood gases and hemodynamic variables were also assessed before and after extubation . RESULTS The evolution was similar for the control and study groups without statistically significant differences of the variables analyzed except for the PaO2 . On comparing the groups , the PaO2 improved significantly ( p = 0.0009 ) with the use of NPPV for 30 minutes after extubation , but there was no statistically significant difference in the PaCO2 ( p = 0.557 ) . CONCLUSION The use of NPPV for 30 minutes after extubation improved oxygenation in the immediate postoperative period of heart surgery BACKGROUND : The aim of our study was to evaluate the pulmonary effects of noninvasive ventilation ( NIV ) with or without recruitment maneuver ( RM ) after open heart surgery . METHODS : One-hundred patients undergoing coronary artery bypass surgery were r and omized into four groups after the operation : 1 ) RM with sustained inflation during mechanical ventilation postoperatively ( RM group , n = 25 ) ; 2 ) RM combined with NIV applied for 1/2-h periods every 6 h in the first postoperative day after tracheal extubation ( RM-NIV group , n = 25 ) ; 3 ) NIV after tracheal extubation ( NIV group , n = 25 ) ; and 4 ) a control group consisting of patients receiving neither RM nor NIV ( control group , n = 25 ) . Pulmonary function tests , oxygenation index , and atelectasis on chest radiograph were evaluated and compared among the groups . RESULTS : RM provided higher arterial oxygen levels during mechanical ventilation and after tracheal extubation compared to other interventions . Oxygenation was better in the RM-NIV and NIV groups than in the control group ( P = 0.02 and P = 0.008 , respectively ) at the end of the study . The postoperative atelectasis score of the control group ( median : 1 ) was higher than those of the RM ( 1 ; P = 0.03 ) , RM-NIV ( 0 ; P < 0.01 ) and NIV ( 0 ; P < 0.01 ) groups . Pulmonary function of the NIV groups on postoperative day 2 was better than in the other groups , whereas the tests were similar among the groups on postoperative day 7 . CONCLUSIONS : NIV associated with RM provided better oxygenation both during and after the mechanical ventilation period . NIV either alone or in combination with RM provided lower atelectasis scores and better early pulmonary function tests compared to the control group , without a significant difference regarding the duration of mechanical ventilation , intensive care unit stay , and the length of hospitalization .  NIV combined with RM is recommended after open heart surgery to prevent postoperative atelectasis and hypoxemia Abstract . Objective : To evaluate non-invasive ventilation ( NIV ) prospect ively in a group of patients developing acute respiratory failure ( ARF ) after bilateral lung transplantation ( BLT ) . Setting : General intensive care unit ( ICU ) of Rome " La Sapienza " University . Patients : Twenty-one patients ( 18 with cystic fibrosis ) undergoing BLT . Results : All consecutive patients developing ARF ( according to predefined criteria ) and requiring ventilatory support , received non-invasive pressure support ventilation through a face-mask ( PEEP 5 cmH2O , PSV 14±2 cmH2O ) for a mean period of 5±4 days . Eighteen out of 21 patients avoided intubation and were discharged from the ICU ; 3 patients required intubation : 1 of them survived while 2 developed septic shock and died . Conclusions : NIV administration was well tolerated and avoided intubation in the large majority of patients ( 86 % ) ; in NIV responders the rate of complications was low and ICU mortality nil . NIV should be considered as an interesting alternative to conventional ventilation in patients who require ventilatory support after BLT CONTEXT Hypoxemia complicates the recovery of 30 % to 50 % of patients after abdominal surgery ; endotracheal intubation and mechanical ventilation may be required in 8 % to 10 % of cases , increasing morbidity and mortality and prolonging intensive care unit and hospital stay . OBJECTIVE To determine the effectiveness of continuous positive airway pressure compared with st and ard treatment in preventing the need for intubation and mechanical ventilation in patients who develop acute hypoxemia after elective major abdominal surgery . DESIGN AND SETTING R and omized , controlled , unblinded study with concealed allocation conducted between June 2002 and November 2003 at 15 intensive care units of the Piedmont Intensive Care Units Network in Italy . PATIENTS Consecutive patients who developed severe hypoxemia after major elective abdominal surgery . The trial was stopped for efficacy after 209 patients had been enrolled . INTERVENTIONS Patients were r and omly assigned to receive oxygen ( n = 104 ) or oxygen plus continuous positive airway pressure ( n = 105 ) . MAIN OUTCOME MEASURES The primary end point was incidence of endotracheal intubation ; secondary end points were intensive care unit and hospital lengths of stay , incidence of pneumonia , infection and sepsis , and hospital mortality . RESULTS Patients who received oxygen plus continuous positive airway pressure had a lower intubation rate ( 1 % vs 10 % ; P = .005 ; relative risk [ RR ] , 0.099 ; 95 % confidence interval [ CI ] , 0.01 - 0.76 ) and had a lower occurrence rate of pneumonia ( 2 % vs 10 % , RR , 0.19 ; 95 % CI , 0.04 - 0.88 ; P = .02 ) , infection ( 3 % vs 10 % , RR , 0.27 ; 95 % CI , 0.07 - 0.94 ; P = .03 ) , and sepsis ( 2 % vs 9 % ; RR , 0.22 ; 95 % CI , 0.04 - 0.99 ; P = .03 ) than did patients treated with oxygen alone . Patients who received oxygen plus continuous positive airway pressure also spent fewer mean ( SD ) days in the intensive care unit ( 1.4 [ 1.6 ] vs 2.6 [ 4.2 ] , P = .09 ) than patients treated with oxygen alone . The treatments did not affect the mean ( SD ) days that patients spent in the hospital ( 15 [ 13 ] vs 17 [ 15 ] , respectively ; P = .10 ) . None of those treated with oxygen plus continuous positive airway pressure died in the hospital while 3 deaths occurred among those treated with oxygen alone ( P = .12 ) . CONCLUSION Continuous positive airway pressure may decrease the incidence of endotracheal intubation and other severe complications in patients who develop hypoxemia after elective major abdominal surgery Objective An investigation into the incidence of post-operative complications after thoracic surgery with  3 different physiotherapy masks . Design A prospect i ve , consecutive , r and omized comparison . Setting Department of Thoracic and Heart Surgery at a University Hospital . The treatments were performed by experienced and specially trained physiotherapists . Patients 160 patients were evaluated . 60 patients undergoing heart surgery , 59 patients having pulmonary resection , and 41 patients with exploratory thoractomy . Interventions In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy . These were either continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , or inspiratory resistance — positive expiratory pressure ( IR-PEP ) . Measurements and results Post-operative pulmonary complications were assessed by forced vital capacity ( FVC ) , arterial oxygen tension ( PaO2 ) , and chest X-ray examination , all measured pre-operatively and on the fourth and ninth post-operative day . The patients filled in a question naire expressing their opinion about their mask treatment . There was an equal decrease in FVC , FVC% , and PaO2 , and equal frequency of atelectasis in the 3 mask treatments . More patients with the PEP mask favoured their system than did those with the other 2 systems . Conclusion There was no statistically significant difference between the treatments : continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , and inspiratory resistance — positive expiratory pressure ( IR-PEP ) on post-operative complications . Any of the three treatments may be used as supplement to st and ard chest physiotherapy Pulmonary complications are frequently seen after thoracoabdominal resection of the oesophagus . The aim of this study was to compare the effects of two different breathing exercise regimens applied in the immediate postoperative period on the risk of pulmonary insufficiency after thoracoabdominal resection STUDY OBJECTIVES It has been suggested that noninvasive mechanical ventilation ( NIMV ) may be a time-consuming procedure for medical and paramedical personnel . We carried out a prospect i ve trial in 10 consecutive COPD patients aim ed at assessing the human and economic re sources needed to ventilate patients by NIMV and we compared these with those needed by a group of six patients receiving invasive mechanical ventilation ( InMV ) .  DESIGN The daily cost and the minutes spent by medical doctors ( MDs ) , respiratory therapists ( RTs ) , and nurses ( Ns ) were recorded during the first 48 h of ventilation in 10 patients during NIMV ( group A ) and in six who received InMV ( group B ) after an initial unsuccessful attempt with NIMV . In two subgroups of patients ( five for group A and four for group B ) , the analysis was also performed , except for RTs , for the total length of mechanical ventilation . SETTING A respiratory ICU . PATIENTS At hospital admission , the two groups of COPD patients did not differ for blood gas values ( PaCO2 = 88.2+/-9.8 mm Hg for group A vs 90.5+/-12.8 mm Hg for group B , and pH = 7.21 + 0.08 vs 7.20 + 0.08 , respectively ) or for clinical and neurologic status , but patients of group B had not tolerated NIMV . MEASUREMENTS AND RESULTS The total time spent at the bedside in the first 6 h did not differ between group A and B ( group A = 72.3 min [ MD ] , 87.2 min [ RT ] , and 178.8 min [ N ] vs 98.8 min [ MD ] , 12.5 min [ RT ] , and 197.6 min [ N ] for group B ) . In the following 42 h , a plateau was reached so that there was a significant reduction for both groups in the time of assistance given by Ns ( p<0.001 ) but not by MDs or RTs . The total costs were also not different between the two groups ( $ 806+/-73 [ US dollars per day ] vs $ 864+/-44 for group A and B , respectively ) . In the subgroups monitored for the entire period of ventilation , a significant reduction in the time of assistance , for both MDs and Ns , was observed after approximately the first half . CONCLUSIONS We conclude that in the first 48 h of ventilation , daily NIMV is neither more expensive nor time-consuming and staff dem and ing than InMV . After the first few days of ventilation , NIMV was significantly less time-consuming than InMV , for MDs and Ns , so that medical and paramedical time expenditure seems not to be a major problem during NIMV QUESTION OF THE STUDY We studied whether prophylactic use of noninvasive pressure support ventilation ( NIPSV ) administered pre- and postoperatively may reduce the postoperative pulmonary function impairment . PATIENTS AND METHODS Prospect i ve r and omized clinical trial . Thirty-nine patients with a preoperative FEV(1 ) < 70 % of the predicted value scheduled for elective lobectomy related to lung cancer were enrolled . Seven patients were excluded after enrollment . Patients were required to follow st and ard treatment without ( control group , n=18 ) or with NIPSV ( study group , n=14 ) during 7 days at home before surgery , and during 3 days postoperatively . Primary outcome variable was the changes on arterial blood gases on room air . RESULTS Two hours after surgery , PaO(2 ) , FVC and FEV(1 ) values were significantly better in the NIPSV group . On day 1 , 2 and 3 , PaO(2 ) was significantly improved in the NIPSV group . Also on day 1 , FVC and FEV(1 ) improved significantly in the NIPSV group . The hospital stay was significantly longer in the control group than in the study group ( p=0.04 ) . The incidence of major atelectasis was 14.2 % in the NIPSV group and 38.9 % in the no-NIPSV group ( p=0.15 ) . ANSWER TO THE QUESTION : Prophylactic use of NIPSV in a pre- and postoperative manner significantly reduces pulmonary dysfunction after lung resection . As a result , recovery of preoperative respiratory function is accelerated Pulmonary oxygen transfer , defined by PaO2/FIO2 , and radiologic presence of atelectasis were measured pre- , intra- , and postoperatively to postoperative day 9 in elective cardiac aortocoronary bypass surgical patients , who were r and omly allocated either to receive 18 h PEEP while on the ventilator followed by 12 h of nasal continuous positive airway pressure ( nasal CPAP ) or  to  be control subjects .  The two groups were comparable in age , sex , forced expiratory volume in 1 sec ( FEV1 ) , the ratio of FEV1 over forced vital capacity ( FVC ) , time on pump , units of blood transfused , New York Heart Association grading , and cardiac performance indices . The PaO2/FIO2 was significantly ( p less than .05 ) better from half an hour after extubation until 24 h postextubation in the nasal CPAP group , but was decreased for the remainder of the study in both groups . Incidence of atelectasis/consolidation was not different in both groups during the study period . We conclude that nasal CPAP is well tolerated as a treatment of hypoxemia in the immediate postoperative period of aortocoronary bypass patients . CPAP does not change the course of postoperative atelectasis Thirty patients who underwent coronary artery bypass grafting were r and omized to receive 30 % oxygen by mask either with an ambient airway pressure or with 7.4 mmHg ( 1 kPa ) continuous positive airway pressure ( CPAP ) for 8 h after extubation . Arterial blood oxygen tension ( Pao2 ) decreased remarkably in the control group after extubation ( from 19.2± 5.3 kPa to 12.4 ± 2.7 kPa ) but less in the CPAP group ( from 16.4 ± 3.3 kPa to 14.0 ± 2.1 kPa ) . On the second postoperative morning Pao2 was equally low in both groups ( control : 8.4 ± 1.5 kPa , CPAP : 8.9 ± 1.9 kPa ) . Atelectatic areas were seen with similar frequency in both groups , 17 % ( whole material ) on the first and 50 % on the second postoperative morning . Atelectasis was more common in patients with internal thoracic artery grafting and /or pleural drainage . In conclusion , CPAP therapy was well tolerated , and minimized the decrease in Pao2 after extubation , but could not prevent the poor oxygenation or the late development of atelectatic areas on the second postoperative day Of 38 patients undergoing median sternotomy for cardiac operations all developed profound restrictive defects in pulmonary function during the first 72 h after tracheal extubation . Although decreased lung volumes were refractory to correction by vigorous , aggressive pulmonary therapy during this period , frequent and supervised treatment may prevent further deterioration in pulmonary function . The overall incidence of pneumonia was only 3 % ( 1/38 ) . Continuous positive airway pressure delivered by mask proved to be a nearly effortless form of postoperative respiratory therapy that was less painful than incentive spirometry or coughing and deep breathing , and therefore may be preferable OBJECTIVE To examine ventilatory response , oxygenation-related , and hemodynamics of patients with hypoxemic acute respiratory failure ( ARF ) su bmi tted to noninvasive mechanical ventilation ( NIV ) during the postoperative phase of cardiovascular surgery in order to identify predictive variables of success , and to compare the different types of NIV . METHODS Seventy patients with hypoxemic ARF were r and omized to one of three modalities of NIV -- continuous positive airway pressure ( CPAP ) and ventilation with two pressure levels ( PEEP + SP and BiPAP ) .  Ventilation , oxygenation-related , and hemodynamics variables were analyzed at pre-application , and 3 , 6 , and 12 hours after the protocol began . RESULTS Thirteen patients were excluded . Thirty-one patients progressed to independence from ventilatory support and comprised the success group , and 26 required orotracheal intubation and were considered the nonsuccess group . Age , initial heart rate ( HR ) , and respiratory rate ( RR ) showed elevated levels in the nonsuccess group ( p=0.042 , 0.029 , and 0.002 , respectively ) . A greater number of intraoperative complications were seen in the nonsuccess group ( p=0.025 ) . Oxygenation variables increased only in the success group . Among the NIV types , 57.9 % of patients in the ventilator group , 57.9 % in the two-pressure levels group , and 47.3 % in the CPAP group progressed with success . Oxygenation and RR variables showed improvement only in the groups with two pressure levels . CONCLUSION Patients with hypoxemic ARF in the postoperative stage after cardiovascular surgery showed better oxygenation , RR , and HR during NIV application . In older patients and those with higher baseline RR and HR values , NIV was not sufficient to reverse ARF . The two-pressure level modes showed better results OBJECTIVE Prospect i ve r and omized controlled study was conducted to explore the effects and safety of prophylactic use of noninvasive positive pressure ventilation ( NPPV ) in post-thoracic surgery ( PTS ) patients , especially on the lung re-expansion , lung function change and postoperative pulmonary complications ( PPCs ) . METHODS Fifty PTS patients met the inclusion criterion were enrolled in the study . All subjects were r and omly divided into conventional treatment ( control ) group and NPPV group . NPPV group received intermittent NPPV therapy in first three days of PTS . BiPAP ventilator was used with S/T mode in the study . The average IPAP was (13±3.2)cmH(2)O ( ranged from 7 to 18 cmH(2)O ) and EPAP was 4cmH(2)O. Total ventilation time was ( 13.5±4.9 ) hours ( ranged from 6.5 to 23 hours ) . PPCs rate , lung re-expansion , the volume of residual cavity , lung function and tolerance to NPPV were assessed with chest roentgenography , CT scan , lung function testing and clinical evaluation before and one week after surgery . RESULTS 1 . There was no significant difference of total PPCs rate during hospitalization between the two groups ( 5/23 in NPPV group vs 6/27 in control group , P= 0.967 ) . Multiple factorial logistic regression analysis showed that COPD was a risk factor for PPCs ( B=1.705 , P=0.027 ) . 2 . Compared with control group , NPPV therapy reduced inadequate lung expansion rate ( 3/23 vs 13/27 , P=0.008 ) and volume of residual cavity calculated with CT scan [ (31.9±71.7)ml vs (63.6±78.3)ml , P=0.02 ] . However , there were no significant difference in the change of lung function parameters after operation between the two groups ( all P>0.05 ) . No significant adverse effects of NPPV were found in the present study . CONCLUSIONS In the current study of prophylactic application of NPPV in post-thoracic surgery patients , the use of NPPV result ed in improved lung re-expansion , but had no significant effects on post-operative pulmonary complications and lung functions
OBJECTIVE To estimate the effect of non-invasive mechanical ventilation ( NIV ) on the rate of reintubation among patients undergoing cardiothoracic surgery .