Chest
Clinical Investigations in Critical CareNasal Continuous Positive Airway Pressure: A Method to Avoid Endotracheal Reintubation in Postoperative High-risk Patients With Severe Nonhypercapnic Oxygenation Failure
Section snippets
Materials and Methods
Patients were recruited prospectively for this study and entered the ICU following thoracic, abdominal, or combined thoracoabdominal procedures. Postoperatively, they received MV until criteria for extubation were fulfilled: Pao2> 70 mm Hg, with fraction of inspired oxygen (Fio2) < 0.35 and positive end-expiratory pressure ≤ 5 cm H2O; normocapnia, with pressure support ≤ 5 cm H2O; rectal temperature > 36.6°C, and a stable cardiovascular system (ie, systolic BP > 100 mm Hg, heart rate < 120
Results
Demographic data, body mass index, operative procedures, acute physiology and chronic health evaluation II score, and mortality data are shown in Table 1 . Mean Paco2 before nCPAP was 43.0 ± 2.0 mm Hg, and did not change with nCPAP (43.0 ± 1.5 mm Hg). No patient had hypercapnic respiratory failure. Ten patients received dobutamine (9.7 ± 1.02 μg/kg/min1), the dosages of which did not change significantly during the first 3 h of nCPAP.
Deterioration of pulmonary oxygen transfer was from severe
Discussion
We showed that nCPAP can substantially improve pulmonary oxygen transfer and avoid the need for EI and MV in patients after major surgery who developed—after an interval of well being—severe and progressive nonhypercapnic respiratory failure.
Following extended cardiac, vascular, or abdominal surgery, patients may develop pulmonary complications, such as atelectasis,14 consolidation of lung areas, or pneumonia.15 Pulmonary gas exchange can additionally be impaired by left heart failure following
References (22)
- et al.
Continuous positive airway pressure effect on functional residual capacity, vital capacity, and its subdivisions
Chest
(1987) - et al.
Effect of failed extubation on the outcome of mechanical ventilation
Chest
(1997) - et al.
Reappraisal of continuous positive airway pressure therapy in acute cardiogenic pulmonary edema
Chest
(1995) - et al.
Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema
Am J Cardiol
(1985) - et al.
Characterization of N-acetylcysteine and ambroxol in anti-oxidant therapy
Respir Med
(1998) - et al.
Effect of nasal continuous positive airway pressure on cardiac output and oxygen delivery in patients with congestive heart failure
Chest
(1992) - et al.
Side effects of nasal continuous positive airway pressure in sleep apnea syndrome
Chest
(1995) - et al.
Postextubation hypoxemia treated with a continuous positive airway pressure mask
Crit Care Med
(1985) - et al.
Comparison of mask and nasal continuous positive airway pressure after extubation and mechanical ventilation
Crit Care Med
(1993) - et al.
Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask
N Engl J Med
(1991)