Extended-time of Noninvasive Positive Pressure Ventilation Improves Tissue Perfusion after Coronary Artery Bypass Surgery: a Randomized Clinical Trial

Abstract

ObjectiveTo compare the effects of extended- versus short-time noninvasive positive pressure ventilation on pulmonary function, tissue perfusion, and clinical outcomes in the early postoperative period following coronary artery bypass surgery in patients with preserved left ventricular function.MethodsPatients were randomized into two groups according to noninvasive positive pressure ventilation intensity: short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and extended-time noninvasive positive pressure ventilation n=21 (E-NPPV). S-NPPV was applied for 60 minutes during immediate postoperative period and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was performed for at least six hours during immediate postoperative period and 60 minutes, twice daily, from postoperative days 1-5. As a primary outcome, tissue perfusion was determined by central venous oxygen saturation and blood lactate level measured after anesthetic induction, immediately after extubation and following noninvasive positive pressure ventilation protocols. As a secondary outcome, pulmonary function tests were performed preoperatively and in the postoperative days 1, 3, and 5; clinical outcomes were recorded. ResultsSignificant drop in blood lactate levels and an improvement in central venous oxygen saturation values in the E-NPPV group were observed when compared with S-NPPV group after study protocol (P<0.01). The E-NPPV group presented higher preservation of postoperative pulmonary function as well as lower incidence of respiratory events and shorter postoperative hospital stay (P<0.05).ConclusionProphylactic E-NPPV administered in the early postoperative period of coronary artery bypass surgery resulted in greater improvements in tissue perfusion, pulmonary function and clinical outcomes than S-NPPV, in patients with preserved left ventricular function.Trial RegistrationBrazilian Registry of Clinical trial - RBR7sqj78 - http://www.ensaiosclinicos.gov.br

Impact of Non-Invasive Ventilation Immediately After Extubation on Clinical and Functional Outcomes in Patients Submitted to Coronary Artery Bypass Grafting: Clinical Trial

“…Another fundamental point in this discussion is that NIV tends to improve the performance of the left ventricle, optimizing cardiac output and improving tissue perfusion 21 . This contributes to improving the functional capacity of these patients.…”

S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

“…So konnten Matte et al 283 bei Patienten nach aorto-koronarer Bypass-Operation allein durch die Anwendung von Masken-CPAP 4 Stunden nach Extubation im Vergleich zur konventionellen Therapie (inzentive Spirometrie, Physiotherapie) die Vitalkapazität (Vital Capacity, VC), das forcierte Einsekundenvolumen (Forced Expiratory Volume in one second, FEV1) und die Oxygenierung signifikant verbessern sowie die venöse Beimischung reduzieren. Für postoperative NIV-Phasen von 2-mal täglich 60 min bis zum 5. postoperativen Tag (vs. 2-mal 10 min) konnten Nasrala et al anhand der zentralvenösen Sättigung und des Serum-Lactat-Spiegels neben der Verbesserung der Lungenfunktion auch eine Verbesserung der Gewebeperfusion nachweisen 280 . Cordeiro et al untersuchten in einem RCT den Therapieeinfluss unterschiedlicher PEEP-Niveaus (10 vs. 12 vs. 15 cmH 2 O) unter NIV am ersten postoperativen Tag nach koronarer Bypass-OP 282 .…”

“…V. a. bei Risikoeingriffen wie aortokoronarer Bypass-, Thoraxund Abdominalchirurgie und Zwei-Höhlen-Eingriffen konnte sowohl in prospektiven Interventionsstudien [218,267,[270][271][272][273][274] als auch in weiteren randomisierten Studien [275][276][277][278][279][280][281][282] eine Verbesserung der postoperativen Lungenfunktion erreicht werden. So konnten Matte et al [283] bei Patienten nach aorto-koronarer Bypass-Operation allein durch die Anwendung von Masken-CPAP 4 Stunden nach Extubation im Vergleich zur konventionellen Therapie (inzentive Spirometrie, Physiotherapie) die Vitalkapazität (Vital Capacity, VC), das forcierte Einsekundenvolumen (Forced Expiratory Volume in one second, FEV1) und die Oxygenierung signifikant verbessern sowie die venöse Beimischung reduzieren.…”