Noninvasive ventilation to prevent clinically significant postoperative pulmonary complicationsafter cardiac surgery

Authors: L.A. Bockeria, E.Z. Golukhova, A.T. Medressova, S.N. Kazanovskaya

Company: A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation


For citation: Bockeria L.A., Golukhova E.Z., Medresova A.T., Kazanovskaya S.N. Noninvasive ventilation to prevent clinically significant postoperative pulmonary complications after cardiac surgery. Creative Cardiology. 2014; 1: 37-47

Keywords: postoperative pulmonary complication respiratory physical therapy noninvasive positive-pressure ventilation positive airway pressure

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Abstract

Objective. Despite numerous advances in pre-, intra-, and postoperative care, postoperative pulmonary complications (PPC) are the most common complications observed and managed after abdominal or cardiothoracic surgery. The aim of this study was to assess the efficacy of noninvasive ventilation (NIV) in prevention postoperative pulmonary complications after cardiac surgery in patients at increased risk. Material and methods. The study included 61 patients after various cardiac surgery at high risk for the PPC developing scale we have created, which were divided into two groups: 1) NIV group (main group) – patients in the early postoperative period were conducted NIV plus breathing exercises (n=30; 22 men and 8 women); 2) control group – was prescribed the standard treatment – oxygen therapy and breathing exercises (n=31; 26 men and 5 women). Age of patients ranged from 18 to 73 years (mean 54.4±10). The presence of clinically significant pulmonary complications in the early postoperative period (up to 5 days after surgery), and length of hospital stay after surgery were the first and second endpoints of the study. All patients in the postoperative period (up to discharge) held daily sessions of the breathing exercises and percussion and postural massage with elements of rubbing and vibration, performed on the back muscles. In the main group NIV with oxygen (4–7 l/min) was connected 3 hours after extubation to the patient and held sessions in bi-level positive airway pressure mode (BiPAP). The total duration of NIV (from the beginning until the termination of the method) was 12–18 hours. Results. Noninvasive ventilation significantly reduced the presence of clinically significant PPC (the first endpoint), which in the main group were observed in 8 (26.7%) patients, while in the control group – 21 (67.7%) patients. But the duration of postoperative hospitalization (second endpoint) was significantly higher in the study group (15.2±3.7 days vs 12.1±5.9 control group; p=0.0173), which is likely due to heavier patients condition and the presence of a larger number of other (non-pulmonary) complications in this group. Complications associated with NIV, not met, probably due to intermittent mode of application of this method. Conclusion. Noninvasive ventilation is a highly effective method for the prevention of postoperative pulmonary complications in patients undergoing cardiac surgery with a high risk of their development.

References

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Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery