PURPOSE:Non-invasive positive pressure ventilation (NIPPV) has become a standard of care in acute respiratory failure. However, limited data is available on its usefulness among patients who develop acute respiratory failure after a cardiovascular surgery. The study aimed to describe the outcomes of NIPPV in terms of reintubation rate, lenght of ICU and hospital stay and in- hospital mortality among these group of patients. The characteristics of patients and the factors associated with specified outcomes will be described.
METHODS:To examine the outcome of NIPPV, we performed an analysis of retrospectively gathered data involving 38 patients who developed acute respiratory failure within 48 hours post-extubation for a cardiovascular surgery in a two-year period.
RESULTS:Twenty-seven patients (71%) was successfully managed with NIPPV and eleven patients (29%) failed with NIPPV and were subsequently intubated. Among the eleven reintubated, six patients (15.8 %) eventually died. There is a significantly less ICU days among those who succeed (6.63+ 2.20 days) than those who failed ( 11.8+ 3.52 days)with NIPPV(p-value 0.00). The same trend with the total hospital stay that is 21.04 + 8.18 days and 23.63+7.98 days with a p-value of 0.0428 for successful and failed NIPPV respectively.Patients who tend to succeed with NIPPV have low APACHE II scores(p-value=0.001), absence co-morbidity specifically COPD (p-value=0.011), absence of complications like hospital acquired pneumonia (p-value=0.001), acute renal failure (p-value= 0.004) and cardiac arrythmias (p-value=0.004) The duration and urgency of surgery showed no significance with outcome of NIPPV, however valve surgery (p-value= 0.019)showed better success rate than other type cardiovascular surgery.
CONCLUSION:The outcomes showed favorable benefits with the use NIPPV as compared to reintubation among these subset of patients. Specific patient characteristics were identified as factors correlated with success or failure of NIPPV.
CLINICAL IMPLICATIONS:This study further reflected the benefits and advantages of NIPPV use in the management of acute respiratory failure among another group of subjects,the post-cardiac surgery patients. This affirms the varied indications and significant role af NIPPV in the management of respiratory failure.
DISCLOSURE:Lemuel Umahag, No Financial Disclosure Information; No Product/Research Disclosure Information