Objectives: To study whether nasal continuous positive
airway pressure (nCPAP) improves pulmonary oxygen transfer and avoids
reintubation in patients with severe nonhypercapnic oxygenation failure
after major cardiac, vascular, or abdominal surgery.
Design: Prospective interventional study.
Setting: Surgical ICU of a university hospital.
Patients: Twenty consecutive patients after thoracic,
abdominal, or combined thoracoabdominal operations, in whom pulmonary
oxygen transfer deteriorated continuously following elective extubation
after initial mechanical ventilation. Respiratory failure was due to
atelectasis and/or left heart failure, and all patients met predefined
criteria for reintubation.
therapy (8 to 10 cm H2O) was initiated if
Pao2 had decreased to < 80 mm Hg despite
application of 100% oxygen (flow, 25 L/min), intermittent mask
continuous positive airway pressure, and maximum conventional
Measurements and results: nCPAP treatment was
started 24.1 ± 3.4 h after elective extubation.
Pao2 was < 80 mm Hg in all patients, in 13
patients it was < 60 mm Hg, and in 3 patients it was < 50 mm Hg.
Mean Pao2/fraction of inspired oxygen
(Fio2) ratio had decreased to 60 ± 2.6, and
increased within the first hour of nCPAP to 136 ± 12 (p < 0.001).
The clinical condition in all patients improved further, and after
35.2 ± 6.3 h, all patients were well oxygenated by face mask at
146 ± 14). Two patients were reintubated for reasons unrelated to
oxygenation or ventilation (data are presented as mean ± SEM).
Conclusions: nCPAP is safe, easy to apply, and effective to
improve arterial blood oxygenation in < 1 h in postoperative patients
with severe nonhypercapnic oxygenation failure. In these patients, who
otherwise would have been reintubated, nCPAP can avoid endotracheal
reintubation and mechanical ventilation.