Nasal continuous positive airway pressure: A method to avoid endotracheal reintubation in postoperative high-risk patients with severe nonhypercapnic oxygenation failure.
OBJECTIVE
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.


METHODS
Prospective interventional study.


METHODS
Surgical ICU of a university hospital.


METHODS
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.


METHODS
nCPAP therapy (8 to 10 cm H(2)O) was initiated if PaO(2) had decreased to < 80 mm Hg despite application of 100% oxygen (flow, 25 L/min), intermittent mask continuous positive airway pressure, and maximum conventional therapy.


RESULTS
nCPAP treatment was started 24.1 +/- 3.4 h after elective extubation. PaO(2) 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 PaO(2)/fraction of inspired oxygen (FIO(2)) 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 ambient pressure (PaO(2)/FIO(2) ratio, 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.
Kindgen-Milles
D
D
Department of Clinical Anesthesiology, Heinrich-Heine-University Düsseldorf, Germany. kindgen@uni-duesseldorf.de
Buhl
R
R
Gabriel
A
A
Böhner
H
H
Müller
E
E
D001784:Blood Gas Analysis; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery; D006785:Hospitals, University; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009666:Nose; D010100:Oxygen / Q000378:metabolism*; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000150:complications / Q000601:surgery; D011653:Pulmonary Diffusing Capacity; D012124:Respiratory Care Units; D012131:Respiratory Insufficiency / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D017211:Treatment Failure
D010100:Oxygen