Chest
Volume 128, Issue 2, August 2005, Pages 821-828
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Clinical Investigations
Nasal-Continuous Positive Airway Pressure Reduces Pulmonary Morbidity and Length of Hospital Stay Following Thoracoabdominal Aortic Surgery

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Study objectives

Patients who undergo surgical repair of thoracoabdominal aortic aneurysms have a high risk for the development of respiratory complications, which cause significant postoperative morbidity and prolong hospitalization, compared to patients who undergo other types of surgery. We studied whether prophylactic noninvasive application of nasal continuous positive airway pressure (nCPAP) administered via a facemask immediately after extubation may reduce pulmonary morbidity and shorten the length of hospitalization

Design

Prospective randomized clinical trial

Setting

Surgical ICU of a university hospital

Patients

Fifty-six patients following elective prosthetic replacement of the thoracoabdominal aorta, of whom 6 patients were excluded because they had received prolonged mechanical ventilation

Interventions

Following extubation in the ICU, nCPAP was applied for 12 to 24 h at an airway pressure of 10 cm H2O to patients in the study group (n = 25). Subjects in the control group (n = 25) received standard treatment including intermittent nCPAP (10 cm H2O for 10 min) every 4 h

Measurements and results

In the study group, nCPAP was applied for a mean (± SD) duration of 23 ± 3 h at an airway pressure of 10 ± 1 cm H2O, which improved pulmonary oxygen transfer without altering hemodynamics (ie, heart rate, mean arterial BP, and central venous pressure). The application of nCPAP was associated with fewer pulmonary complications (Pao2/fraction of inspired oxygen [Fio2] <100, atelectasis, pneumonia, reintubation rate) compared to the control group (7 of 25 patients vs 24 of 25 subjects, respectively; p = 0.019). The mean duration of intensive care treatment tended to be shorter in the study group compared to the control group (8 ± 1 vs 12 ± 2 days, respectively; difference not significant), while the mean length of hospital stay was shorter with nCPAP therapy (22 ± 2 vs 34 ± 5 days, respectively; p = 0.048)

Conclusions

The prophylactic application of nCPAP at airway pressures of 10 cm H2O significantly reduced pulmonary morbidity and length of hospital stay following the surgical repair of thoracoabdominal aortic aneurysms. Thus, it can be recommended as a standard treatment procedure for this patient group

Section snippets

Materials and Methods

The study was approved by the committee of medical ethics of the Heinrich-Heine-University of Düsseldorf and was conducted in accordance with the principles outlined in the Declaration of Helsinki. Patients who are scheduled for elective surgical repair of thoracoabdominal aortic aneurysms of types I to III, according to the Crawford classification, were eligible for the study. All consecutive patients who had undergone surgery during 1 year were informed about the study and, in brief, were

Results

We recruited 56 consecutive patients following elective prosthetic replacement of the thoracoabdominal aorta. Six patients were excluded because they could not be extubated within < 48 h. Of these, five patients developed paraplegia, and four of them died, while the other two patients survived after prolonged intensive care therapy.

Accordingly, 50 patients were randomized (control group, 25 patients; study group, 25 patients). The subcategories of thoracoabdominal aortic aneurysms (using the

Discussion

The natural history of patients with thoracoabdominal aortic aneurysms that have not been surgically treated is characterized by a poor outcome. In four large studies,3, 13, 14, 15 it was shown that rupture rates are within the range of 42 to 73% within the first years following diagnosis. The 5-year survival rates in these cohorts were 13 to 39% with rupture of the aneurysm being the most common cause of death.3, 13, 14, 15 Some studies 3 have shown that the extent of the aneurysm, as

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