Skip to main content
 

Main menu

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Coming Next Month
    • Archives
    • Most-Read Papers of 2021
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Reviewer Guidelines: Original Research
    • Reviewer Guidelines: Reviews
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • 2022 Call for Abstracts
    • 2021 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语
  • Videos
    • Video Abstracts
    • Author Interviews
    • Highlighted Articles
    • The Journal

User menu

  • Subscribe
  • My alerts
  • Log in

Search

  • Advanced search
American Association for Respiratory Care
  • Subscribe
  • My alerts
  • Log in
American Association for Respiratory Care

Advanced Search

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Coming Next Month
    • Archives
    • Most-Read Papers of 2021
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Reviewer Guidelines: Original Research
    • Reviewer Guidelines: Reviews
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • 2022 Call for Abstracts
    • 2021 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语
  • Videos
    • Video Abstracts
    • Author Interviews
    • Highlighted Articles
    • The Journal
  • Twitter
  • Facebook
  • YouTube
LetterCorrespondence

Noninvasive Ventilation after Surgical Myocardial Revascularization for Left-Ventricular Dysfunction: A Hypothesis-Generating Study

Antonio M Esquinas and Luca Salvatore De Santo
Respiratory Care January 2019, 64 (1) 115-116; DOI: https://doi.org/10.4187/respcare.06510
Antonio M Esquinas
Intensive Care and Noninvasive Ventilatory Unit Hospital General Universitario Morales Meseguer Murcia, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Luca Salvatore De Santo
Cardiac Surgery Division Clinica Montevergine, GMV Health Care and Research Mercogliano, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • References
  • Info & Metrics
  • PDF
Loading

To the Editor:

Noninvasive ventilation (NIV) affects both the pulmonary and the cardiovascular systems. Indeed, it restores lung volume by opening atelectatic areas, increases alveolar ventilation, and reduces the work of breathing. Moreover, NIV reduces left ventricle afterload and improves cardiac output.

Currently, high-quality evidence supports the use of NIV after cardiac surgery because it significantly improves the patient's oxygenation and decreases the need for endotracheal intubation without significant complications. However, data about improvement of cardiovascular function are scarce, and a mild reduction of the cardiac function due to NIV has been reported. Thus, a judicious application is wise, with constant hemodynamic monitoring in case of reduced left ventricular function. In this line, we read with great interest the study by Marcondi et al,1 which evaluated the acute effects of NIV on central-venous oxygen saturation (Sc̄vO2) and blood lactate in subjects with left ventricular dysfunction during the early postoperative phase of coronary artery bypass graft surgery.1 The authors found that NIV acutely improved Sc̄vO2 and decreased lactatemia, two known determinants of survival.2 The authors are to be commended for their pioneering approach, nevertheless a few key aspects require comment to strengthen the message of the paper.

The timing of NIV implementation (ie, early after extubation) and the short duration of the application (ie, 1 h) raise clinical and physiological concerns. Similarly, there was no mention of the intra-operative course, data from hemodynamic monitoring, or concomitant medical or invasive therapy (eg, inotropic drugs, intra-aortic balloon pumping). Without these data, the interpretation of mere biochemical markers might be misleading.3 Moreover, the study sample is ample but poorly characterized, and stratification according to surgical technique might introduce further bias. Indeed, according to institutional practice, an on-pump technique might be a surrogate marker of more demanding revascularization, lower hemodynamic stability, less atherosclerotic burden, or surgeon expertise. A new target population has been clearly identified, but the inherent merits of NIV require further investigation.

Footnotes

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2019 by Daedalus Enterprises

References

  1. 1.↵
    1. Marcondi NO,
    2. Rocco IS,
    3. Bolzan DW,
    4. Pauletti HO,
    5. Begot I,
    6. Anjos NR,
    7. et al
    . Noninvasive ventilation after coronary artery bypass grafting in subjects with left-ventricular dysfunction. Respir Care 2018;63(7):879–885.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Laine GA,
    2. Hu BY,
    3. Wang S,
    4. Thomas Solis R,
    5. Reul GJ Jr.
    . Isolated high lactate or low central venous oxygen saturation after cardiac surgery and association with outcome. J Cardiothorac Vasc Anesth 2013;27(6):1271–1276.
    OpenUrl
  3. 3.↵
    1. O'Connor E,
    2. Fraser JF
    . The interpretation of perioperative lactate abnormalities in patients undergoing cardiac surgery. Anaesth Intensive Care 2012;40(4):598–603.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Respiratory Care: 64 (1)
Respiratory Care
Vol. 64, Issue 1
1 Jan 2019
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author

 

Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Association for Respiratory Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Noninvasive Ventilation after Surgical Myocardial Revascularization for Left-Ventricular Dysfunction: A Hypothesis-Generating Study
(Your Name) has sent you a message from American Association for Respiratory Care
(Your Name) thought you would like to see the American Association for Respiratory Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Noninvasive Ventilation after Surgical Myocardial Revascularization for Left-Ventricular Dysfunction: A Hypothesis-Generating Study
Antonio M Esquinas, Luca Salvatore De Santo
Respiratory Care Jan 2019, 64 (1) 115-116; DOI: 10.4187/respcare.06510

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Noninvasive Ventilation after Surgical Myocardial Revascularization for Left-Ventricular Dysfunction: A Hypothesis-Generating Study
Antonio M Esquinas, Luca Salvatore De Santo
Respiratory Care Jan 2019, 64 (1) 115-116; DOI: 10.4187/respcare.06510
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Info & Metrics
  • References
  • PDF

Related Articles

Cited By...

Info For

  • Subscribers
  • Institutions
  • Advertisers

About Us

  • About the Journal
  • Editorial Board
  • Reprints/Permissions

AARC

  • Membership
  • Meetings
  • Clinical Practice Guidelines

More

  • Contact Us
  • RSS
American Association for Respiratory Care

Print ISSN: 0020-1324        Online ISSN: 1943-3654

© Daedalus Enterprises, Inc.

Powered by HighWire