PT  - JOURNAL ARTICLE
AU  - Natasha O Marcondi
AU  - Isadora S Rocco
AU  - Douglas W Bolzan
AU  - Hayanne O Pauletti
AU  - Isis Begot
AU  - Natalia R Anjos
AU  - Rita Simone L Moreira
AU  - Mara L Nasrala
AU  - Ross Arena
AU  - Walter J Gomes
AU  - Solange Guizilini
TI  - Noninvasive Ventilation After Coronary Artery Bypass Grafting in Subjects With Left-Ventricular Dysfunction
AID  - 10.4187/respcare.05851
DP  - 2018 Jul 01
TA  - Respiratory Care
PG  - 879--885
VI  - 63
IP  - 7
4099  - http://rc.rcjournal.com/content/63/7/879.short
4100  - http://rc.rcjournal.com/content/63/7/879.full
AB  - BACKGROUND: The use of noninvasive ventilation in patients with left-ventricular dysfunction may increase cardiac performance by decreasing inspiratory effort and left-ventricular afterload. The aim of the present study was to evaluate the acute effects of noninvasive ventilation on central-venous oxygen saturation (Scv̄O2) and blood lactate in subjects with left-ventricular dysfunction during the early postoperative phase of coronary artery bypass grafting.METHODS: This study included 100 subjects during the postoperative phase of elective coronary artery bypass grafting. Blood samples, at 5 time points, were collected to assess tissue perfusion markers (ie, Scv̄O2 and blood lactate) as follows: (1) the intraoperative period (after anesthesia induction); (2) 20 min after ICU arrival, under intermittent mandatory ventilation; (3) 20 min after extubation with spontaneous breathing; (4) after 1 h of noninvasive ventilation; and (5) 20 min after discontinuation of noninvasive ventilation.RESULTS: A significant increase in the blood lactate and a drop in the Scv̄O2 were observed on arrival to the ICU compared with intraoperative values (P < .001). After extubation, during spontaneous breathing, the Scv̄O2 significantly decreased (P = .02), whereas the blood lactate increased, although not significantly (P = .21) compared with intermittent mandatory ventilation on arrival to the ICU. During the application of noninvasive ventilation, the Scv̄O2 significantly increased (P = .048) and the blood lactate significantly decreased (P = .008) compared with spontaneous breathing values after extubation. After noninvasive ventilation discontinuation, the Scv̄O2 and blood lactate did not change compared with measures taken during noninvasive ventilation; higher values of Scv̄O2 were maintained compared with those obtained after extubation (P < .001).CONCLUSIONS: The acute application of noninvasive ventilation improved Scv̄O2 and decreased the blood lactate in subjects with left-ventricular dysfunction during the early postoperative phase after coronary artery bypass grafting. (ClinicalTrials.gov registration NCT02767687.)