title: Non-invasive ventilation after cardiac surgery outside the Intensive Care Unit.
abstract: BACKGROUND
  Non-invasive ventilation (NIV) can prevent or treat postoperative acute respiratory failure. NIV after discharge from the Intensive Care Unit (ICU) has never been described in the setting of cardiac surgery.
  
  
  METHODS
  This study enrolled 85 patients who received NIV in the main ward as treatment for respiratory failure. The patients had the following conditions: atelectasis (45 patients), pleural effusion (20 patients), pulmonary congestion (13 patients), diaphragm hemiparesis (6 patients), pneumonia (4 patients) or a combination of these conditions.
  
  
  RESULTS
  Eighty-three patients were discharged from the hospital in good condition and without need for further NIV treatment, while two died in-hospital. Four of the 85 patients had an immediate NIV failure, while eight patients had delayed NIV failure. Only one patient had a NIV-related complication represented by hypotension after NIV institution. In this patient, NIV was interrupted with no consequences. Major mistakes were mask malpositioning with excessive air leaks (7 patients), incorrect preparation of the circuit (one patient), and oxygen tube disconnection (one patient). Minor mistakes (sub-optimal positioning of the face mask without excessive air leaks) were noted by the respiratory therapists for all patients and were managed by slightly modifying the mask position.
  
  
  CONCLUSIONS
  In our experience, postoperative NIV is feasible, safe and effective in treating postoperative acute respiratory failure when applied in the cardiac surgical ward, preserving intensive care unit beds for surgical activity. A respiratory therapy service managed the treatment in conjunction with ward nurses, while an anesthesiologist and a cardiologist served as consultants.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Olper
authors.forename: L
authors.initials: L
authors.lastname: Cabrini
authors.forename: G
authors.initials: G
authors.lastname: Landoni
authors.forename: A
authors.initials: A
authors.lastname: Rossodivita
authors.forename: L
authors.initials: L
authors.lastname: Nobile
authors.forename: G
authors.initials: G
authors.lastname: Monti
authors.forename: O
authors.initials: O
authors.lastname: Alfieri
authors.forename: A
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000208:Acute Disease; D000368:Aged; D000776:Anesthesiology; D006348:Cardiac Surgical Procedures; D002309:Cardiology; D005240:Feasibility Studies; D005260:Female; D006757:Hospital Units; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000451:nursing / Q000628:therapy*; D007362:Intensive Care Units; D007380:Intermediate Care Facilities; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010348:Patient Care Team; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000451:nursing / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000451:nursing / Q000628:therapy*; D012138:Respiratory Therapy