Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients.
BACKGROUND
Continuous positive airway pressure is a noninvasive respiratory support technique that may prevent pulmonary complications following cardiac surgery. This study was conducted to determine the efficacy of prophylactic nasal continuous positive airway pressure (nCPAP) compared with standard treatment. The primary end points were pulmonary adverse effects defined as hypoxemia (Pao(2)/fraction of inspired oxygen [Fio(2)] <100), pneumonia, and reintubation. The secondary end point was the readmission rate to the ICU or intermediate care unit (IMCU).


METHODS
We prospectively randomized 500 patients scheduled for elective cardiac surgery. Following extubation either in the operating room (early) or in the ICU (late), patients were allocated to standard treatment (control) including 10 min of intermittent nCPAP at 10 cm H(2)O every 4 h or prophylactic nCPAP (study) at an airway pressure of 10 cm H(2)O for at least 6 h.


RESULTS
Prophylactic nCPAP significantly improved arterial oxygenation (Pao(2)/Fio(2)) without altering heart rate and mean arterial BP. Pulmonary complications including hypoxemia (defined as Pao(2)/Fio(2) <100), pneumonia, and reintubation rate were reduced in study patients compared to controls (12 of 232 patients vs 25 of 236 patients, respectively; p = 0.03). The readmission rate to the ICU or IMCU was significantly lower in nCPAP-treated patients (7 of 232 patients vs 14 of 236 patients, respectively; p = 0.03).


CONCLUSIONS
The long-term administration of prophylactic nCPAP following cardiac surgery improved arterial oxygenation, reduced the incidence of pulmonary complications including pneumonia and reintubation rate, and reduced readmission rate to the ICU or IMCU. Thus noninvasive respiratory support with nCPAP is a useful tool to reduce pulmonary morbidity following elective cardiac surgery.
Zarbock
Alexander
A
Department of Anesthesiology and Critical Care Medicine, University of Muenster, Muenster, Germany. Electronic address: zarbock@uni-muenster.de.
Mueller
Eckhard
E
Department of Anesthesiologie, Intensive Care, and Pain Therapy, Knappschaftskrankenhaus Langendreer-University Hospital, Bochum, Germany.
Netzer
Sabine
S
Department of Anesthesiology and Critical Care Medicine, Klinikum Krefeld, Krefeld, Germany.
Gabriel
Andrea
A
Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany.
Feindt
Peter
P
Department of Thoracic- and Cardiovascular Surgery, University Hospital Düsseldorf, Düsseldorf, Germany.
Kindgen-Milles
Detlef
D
Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany.
D000368:Aged; D006348:Cardiac Surgical Procedures; D045422:Continuous Positive Airway Pressure; D001026:Coronary Artery Bypass; D003422:Critical Care / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D000860:Hypoxia / Q000517:prevention & control*; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008171:Lung Diseases / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010359:Patient Readmission / Q000706:statistics & numerical data; D011014:Pneumonia / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000517:prevention & control; D019233:Retreatment
D010100:Oxygen