Effect of prophylactic non-invasive mechanical ventilation on functional capacity after heart valve replacement: a clinical trial

Abstract

OBJECTIVE:During cardiac surgery, several factors contribute to the development of postoperative pulmonary complications. Non-invasive ventilation is a promising therapeutic tool for improving the functionality of this type of patient. The aim of this study is to evaluate the functional capacity and length of stay of patients in a nosocomial intensive care unit who underwent prophylactic non-invasive ventilation after heart valve replacement.METHOD:The study was a controlled clinical trial, comprising 50 individuals of both sexes who were allocated by randomization into two groups with 25 patients in each group: the control group and experimental group. After surgery, the patients were transferred to the intensive care unit and then participated in standard physical therapy, which was provided to the experimental group after 3 applications of non-invasive ventilation within the first 26 hours after extubation. For non-invasive ventilation, the positive pressure was 10 cm H2O, with a duration of 1 hour. The evaluation was performed on the 7th postoperative day/discharge and included a 6-minute walk test. The intensive care unit and hospitalization times were monitored in both groups. Brazilian Registry of Clinical Trials (REBeC): RBR number 8bxdd3.RESULTS:Analysis of the 6-minute walk test showed that the control group walked an average distance of 264.34±76 meters and the experimental group walked an average distance of 334.07±71 meters (p=0.002). The intensive care unit and hospitalization times did not differ between the groups.CONCLUSION:Non-invasive ventilation as a therapeutic resource was effective toward improving functionality; however, non-invasive ventilation did not influence the intensive care unit or hospitalization times of the studied cardiac patients.

Noninvasive ventilation in acute respiratory failure: which recipe for success?

“…Evidence shows that both CPAP and bilevel NPPV, if applied after evaluation of surgical complications, are safe and can reduce intubation rates, nosocomial infections, length of stay and morbidity and mortality after abdominal, thoracic and cardiac surgery [6]. Further studies are needed to assess the eventual benefit of prophylactic NPPV after surgery [52,53].…”

Prolonged use of noninvasive positive pressure ventilation after extubation among patients in the intensive care unit following cardiac surgery: The predictors and its impact on patient outcome

“…Both continuous positive airway pressure (CPAP) and bilevel NIPPV, if applied after evaluation of surgical complications, are safe and can reduce re-intubation rates, morbidity, and mortality after cardiac surgery 8,22 . In randomized trials, the application of prophylactic CPAP or NIPPV compared to standard treatment with oxygen therapy and chest physiotherapy for a period of 1–12 h improved the gas exchange 5,16,21,23 and functional capacity 9 , but there was no statistical difference in the spirometry 22 , or rate of atelectasis 22,24 . However, Zarbock et al .…”

“…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) 1–3 . In the postoperative period, short-term use of NIPPV has been demonstrated to be beneficial for preventing (prophylactic use) 4–9 and treating (therapeutic use) ARF after extubation 3,8–15 . Notably, patients undergoing cardiac surgery often encounter complications of significant pulmonary dysfunction postoperatively 13 .…”

“…General anesthesia, cardiopulmonary bypass, and pain contribute to postoperative atelectasis after open heart surgery. Prophylactic use of NIPPV after extubation helps alleviate pulmonary function impairment and reduces the risk of postoperative pulmonary complications in these patients 5,8,9,14–16 . Several studies have focused on evaluating the safety and efficacy of prophylactic NIPPV in patients undergoing cardiac surgery 4,5 .…”

Preventive Effect of Albumin Nano TPA Gene Plasmid Ultrasound Microbubble Carrier System on Thrombosis after Cardiac Valve Replacement

“…Albumin nanoparticles can be administered through a variety of ways, such as intravenous injection, intramuscular injection, oral administration, and intra-arterial injection [3,4]. Tissue-type plasminogen activator (tPA) is a tissue plasminogen activator that selectively activates plasmin [5,6]. However, the way in which plasmatype activator gene can be effectively transferred into terminal cells has not been solved.…”