Original article
Postoperative Respiratory Failure After Cardiac Surgery: Use of Noninvasive Ventilation

https://doi.org/10.1053/j.jvca.2011.11.007Get rights and content

Objectives

To analyze the use of noninvasive ventilation (NIV) in respiratory failure after extubation in patients after cardiac surgery, the factors associated with respiratory failure, and the need for reintubation.

Design

Retrospective observational study.

Setting

Intensive care unit in a university hospital.

Participants

Patients (n = 63) with respiratory failure after extubation after cardiac surgery over a 3-year period.

Interventions

Mechanical NIV.

Measurements and Main Results

Demographic and surgical data, respiratory history, causes of postoperative respiratory failure, durations of mechanical ventilation and spontaneous breathing, gas exchange values, and the mortality rate were recorded. Of 1,225 postsurgical patients, 63 (5.1%) underwent NIV for respiratory failure after extubation. The median time from extubation to the NIV application was 40 hours (18-96 hours). The most frequent cause of respiratory failure was lobar atelectasis (25.4%). The NIV failed in 52.4% of patients (33/63) who had a lower pH at 24 hours of treatment (7.35 v 7.42, p = 0.001) and a higher hospital mortality (51.5% v 6.7%, p = 0.001) than those in whom NIV was successful. An interval <24 hours from extubation to NIV was a predictive factor for NIV failure (odds ratio, 4.6; 95% confidence interval, 1.2-17.9), whereas obesity was associated with NIV success (odds ratio, 0.22; 95% confidence interval, 0.05-0.91).

Conclusions

Reintubation was required in half of the NIV-treated patients and was associated with an increased hospital mortality rate. Early respiratory failure after extubation (≤24 hours) is a predictive factor for NIV failure.

Section snippets

Methods

This observational study was conducted in a university hospital ICU to which all adult cardiac surgical patients are transferred from the operating room. The hospital has 1,200 beds and serves a population of 450,000 inhabitants, and the ICU has 42 beds and admits about 2,000 patients annually, of whom around 400 are postoperative cardiac surgical patients. Data were gathered retrospectively on patients admitted from September 2006 through September 2009 from the computerized ICU patient

Results

Of 1,225 patients admitted to the ICU after cardiac surgery during the 3-year study period, 63 (5.1%) were treated with NIV for respiratory failure after the first extubation (Fig 1). Table 1 presents the baseline characteristics and histories of these patients.

In the postoperative unit, the median duration of the initial MV (from surgery to extubation) was 8 hours (range, 5-24 hours) for all patients. In contrast, the median time of the initial MV was 38 hours (range, 8-211 hours) and the

Discussion

The main findings of the present study were that reintubation was necessary for around 50% of postoperative cardiac surgical patients treated with NIV for respiratory failure after extubation and that NIV failure was associated with an increased mortality rate. The early onset (<24 hours) of respiratory failure after extubation was associated with NIV failure, and obesity was associated with NIV success.

Reported NIV failure rates vary and depend on multiple factors, such as the experience of

Acknowledgments

The authors are grateful to Richard Davies for assistance with the English version of this report.

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