Noninvasive Ventilation to Treat Respiratory Failure After Cardiac Surgery: Predictors of Application and Outcome

Abstract

BACKGROUND: Respiratory complications remain a major cause of morbidity in cardiac surgery patients. This study aimed to determine the prognostic parameters associated with the application of noninvasive ventilation (NIV) for the treatment of acute respiratory failure, along with the possible predictors associated with NIV failure, among the subjects who underwent cardiac surgery. METHODS: This was a retrospective cohort study. Data on all adult patients who underwent cardiac surgery in a single center between May 2012 and December 2016 were analyzed. Multivariate regression analysis with bootstrapping was used to identify which baseline and intraoperative parameters were associated with the application of NIV to treat acute postoperative respiratory failure. A univariate analysis was also applied to identify potential variables associated with NIV failure. P < .05 was considered significant. RESULTS: A total of 1,657 subjects (mean ؎ SD age 65.2 ؎ 10.7 y; 21.7% females) constituted the study population, 145 (8.8%) of whom were treated with NIV due to acute postoperative respiratory failure. Body mass index adjusted odds ratio 1.02, bias-corrected 95% CI 1.01-1.04), EuroSCORE (European System for Cardiac Operative Risk Evaluation) II (adjusted odds ratio 1.11, bias-corrected 95% CI 1.02-1.32), COPD (adjusted odds ratio 4.004, bias-corrected 95% CI 2.53-8.93), and preoperative estimated glomerular filtration rate (adjusted odds ratio 0.99, bias-corrected 95% CI 0.98-0.99) independently predicted NIV application. NIV treatment failed in 16 of the 145 subjects (11%) and age, EuroSCORE II, COPD, heart failure, renal replacement therapy, and postoperative stroke were all univariately associated with the outcome. CONCLUSIONS: NIV successfully treated acute respiratory failure in the vast majority of cardiac surgery subjects and COPD, EuroSCORE II, body mass index, and preoperative renal function were independently associated with its application.

Remifentanil versus dexmedetomidine for treatment of cardiac surgery patients with moderate to severe noninvasive ventilation intolerance (REDNIVIN): a prospective, cohort study

“…Noninvasive ventilation (NIV) after cardiac surgery (CS) has been broadly applied in recent years (1)(2)(3). However, NIV is unsuccessful in about 40% to 50% of patients undergoing CS (2,4).…”

S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

“…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.…”

Remifentanil versus Dexmedetomidine in Cardiac Surgery Patients with Noninvasive Ventilation Intolerance: Protocol for the REDNIVI Trial

“…Sedation has been widely accepted as a safe and effective way to manage patients with NIV intolerance [16,27,28]. However, protocols vary greatly.…”