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

Abstract

This retrospective, observational cohort study aimed to determine the independent risk factors and impact of prolonged non-invasive positive pressure ventilation (NIPPV) after extubation among patients in the intensive care unit following cardiac surgery. Patients who received prophylactic NIPPV after extubation were categorized into prolonged (NIPPV duration >3 days, n = 83) and non-prolonged groups (NIPPV duration ≤3 days, n = 105). The perioperative characteristics and hospital outcomes were recorded. The multivariate analyses identified the preoperative residual volume/total lung capacity (RV/TLC) ratio (adjusted odds ratio [AOR]: 1.10; 95% CI:1.01–1.19, p = 0.022) and postoperative acute kidney injury (AKI) with Kidney Disease Improving Global Outcomes (KDIGO) stage 2–3, 48 h after surgery (AOR: 3.87; 95% CI:1.21–12.37, p = 0.023) as independent predictors of prolonged NIPPV. Patients with both RV/TLC ratio > 46.5% and KDIGO stage 2–3 showed a highly increased risk of prolonged NIPPV (HR 27.17, p = 0.010), which was in turn associated with higher risk of postoperative complications and prolonged ICU and hospital stays. Preoperative RV/TLC ratio and postoperative AKI could identify patients at higher risk for prolonged NIPPV associated with poor outcomes. These findings may allow early recognition of patients who are at a higher risk for prolonged NIPPV, and help refine the perioperative management and critical care.

Lived experience of patients inICUafter cardiac surgery: A phenomenological study

“…2 Recent literature shows that the incidence of complications in patients undergoing CS is relatively frequent, with a range of 15% to 30%. 3 Notably, patients often encounter complications such as significant pulmonary dysfunction postoperatively, 4 haemorrhage, stroke, and delirium, 5,6 for which they often remain under-diagnosed. Depending on the methodology, post-CS delirium is diagnosed in 26% to 52% of patients, with some studies reporting percentages as high as 70%.…”

“…Cardiac surgery (CS) involves several challenges, both for the patients and the health care providers, 1‐3 such as frequent incidence of complications, postoperative complications, and high nursing skills required. The high clinical complexity of patients undergoing CS is often associated with numerous complications 1 because of a combination of factors, including higher‐risk surgery, age of patients at the time of surgery, and the presence of comorbid conditions 2 .…”

“…The high clinical complexity of patients undergoing CS is often associated with numerous complications 1 because of a combination of factors, including higher‐risk surgery, age of patients at the time of surgery, and the presence of comorbid conditions 2 . Recent literature shows that the incidence of complications in patients undergoing CS is relatively frequent, with a range of 15% to 30% 3 . Notably, patients often encounter complications such as significant pulmonary dysfunction postoperatively, 4 haemorrhage, stroke, and delirium, 5,6 for which they often remain under‐diagnosed.…”

Influencing factors of noninvasive positive pressure ventilation in the treatment of respiratory failure: a 10-year study in one single center

“…Contou et al [ 23 ] reported that the patients with PaCO 2 > 60 mmHg, compared with the patients with PaCO 2 ≤ 60 mmHg, required longer duration of NPPV treatment and LOS. However, Chen et al [ 24 ] reported 188 patients who received prophylactic NPPV after extubation, according to duration of NPPV treatment, were divided into prolonged (duration of NPPV treatment > 3 days) and non-prolonged groups (duration of NPPV treatment ≤ 3 days). The results made clear that compared with non-prolonged group, prolonged group significantly increased the risk of complications, prolonged ICU and hospital stay, but had no significant effect on mortality.…”

Blood Urea Nitrogen to Serum Albumin Ratio as A New Prognostic Indicator in Critically Ill Patients with Diabetic Ketoacidosis: A Retrospective Cohort Study

“…BUN is usually regarded as an important indicator of blood volume. Although many patients with DKA are complicated with acute renal failure, dehydration is the most common state among patients with DKA due to hypovolemia and hypotension Accepted Manuscript also revealed that high BUN levels are correlated with poor prognosis in ICU patients [24,25]. As high BUN was also found to be related to the poor prognosis of patients with acute heart failure, acute respiratory disease syndrome, and hepatic decompensation [26][27][28], BUN might reflect the degree of injury of multiple important organs, which were also found to be an important risk factor of critically ill patients.…”