Tailoring Noninvasive Ventilation Management in Non-ICU Settings and the Cardiac Surgery Context

Preventive and therapeutic noninvasive ventilation in cardiovascular surgery

“…Thirty-three percent used NIV also on the surgical ward: in most centers the patient on NIV was readmitted in the ICU, but a minority of them left the NIV patient on the ward unless reintubation was eventually required. NIV application in cardiovascular surgery wards is at its beginning, but we should manage to offer effective and well tolerated treatments to a growing number of patients in the next future as part of a comprehensive strategy to reduce postoperative mortality [14,15,39].…”

“…The common shortage of ICU beds, economic reasons, the awareness that NIV is more effective when applied at the early stage of ARF, and a growing confidence with NIV lead to an increasing number of publications on NIV use outside the ICU [37][38][39][40]. In the surgical setting, other factors can induce to consider this opportunity: fast-track surgery may imply that more patients will develop ARF when already discharged from the ICU; readmission to the ICU reduces the ICU beds available for new cases; finally, also patients in labile conditions and at high-risk for PPCs are currently scheduled for surgery, whereas they were often refused in the past.…”