Effects of continuous (CPAP) and bi-level positive airway pressure (BiPAP) on extravascular lung water after extubation of the trachea in patients following coronary artery bypass grafting

Abstract

Mask CPAP and nasal BiPAP after extubation of the trachea prevent the increase in extravascular lung water during weaning from mechanical ventilation. This effect is seen for at least 1 h after the discontinuation of CPAP or BiPAP treatment. Further studies have to evaluate the clinical relevance of this phenomenon.

Benefícios da ventilação não-invasiva após extubação no pós-operatório de cirurgia cardíaca

“…Authors have reported that non-invasive ventilation prevents an increase in the pulmonary extravascular water, thereby reducing complications after extubation in the postoperative period of CABG [11][12][13].…”

“…Studies that evaluated patients submitted to CABG to detect the effects of facial CPAP and nasal BiPAP on extravascular water during weaning from invasive ventilation, observed that, both the use of CPAP and BiPAP for a minimum of 30 minutes after endotracheal extubation prevent increases in the extravascular water and this effect can last for up to 60 minutes after ceasing the treatment, thereby reducing complications after extubation [13]. Other authors reported that non-invasive ventilation utilizing the BiPAP mode was more effective than CPAP and respiratory physiotherapy to improve pulmonary mechanics and oxygenation after CABG [20,21].…”

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

“…169 Although cardiac and thoracic surgery may be considered high-risk procedures, the actual incidence of respiratory failure with these types of surgery is relatively low. 89,91,95,[97][98][99] For the purposes of these guidelines, low risk was necessarily defined by the surgical procedure alone, as no trials specified that their respective patient populations were uniformly at low risk. As such, trials of low-risk surgical procedures might have included patients with comorbidities that would place them in either high-or low-risk categories.…”

“…Trials of the use of noninvasive ventilation in patients who underwent lowrisk surgical procedures were generally small and reported only physiologic outcomes or found no difference in endotracheal intubation, hospital mortality or length of stay. 89,91,95,[97][98][99][102][103][104][105][106][107]109,111 The only exception was a recent large trial of continuous positive airway pressure by mask in 468 patients after cardiac surgery. 101 There was a reduction in a composite end point of pulmonary complications (arterial pressure of oxygen/fraction of inspired oxygen < 100, pneumonia or reintubation) and readmission to the ICU or an intermediate care unit.…”

The effect of non-invasive mechanical ventilation in postoperative respiratory failure

“…Gust ve arkadaşlarının eski bir çalışmasında, hem CPAP hem de BiPAP uygulamasının by-pass cerrahisi sonrası ekstübe edilen hastalarda ekstravasküler ödemi azalttığı gösterilmiştir (22). Daha sonra yapılan ve by-pass cerrahisi sonrası ilk iki gün NIMV uygulaması ile POSY'nin önlenmesinin amaçlandığı bir araştırmada, NIMV ile oksijenizasyonun ve akciğer volümlerinde düzelme sağladığı ancak atelektazi gelişimini azaltmadığı gösterilmiştir (23).…”