title: Continuous Positive Airway Pressure Versus Oxygen Therapy in the Cardiac Surgical Ward: A Randomized Trial.
abstract: BACKGROUND
  Noninvasive ventilation (NIV) is a common technique to manage patients with acute respiratory failure in the intensive care unit. However, use of NIV in general wards is less well described. The authors' aim was to demonstrate efficacy of NIV, applied in a cardiac surgery ward, in improving oxygenation in patients who developed hypoxemic acute respiratory failure after being discharged from the intensive care unit.
  
  
  METHODS
  Randomized, open-label trial.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Sixty-four patients with hypoxemia (PaO2/FIO2ratio between 100 and 250) admitted to the main ward after cardiac surgery.
  
  
  METHODS
  Patients were randomized to receive standard treatment (oxygen, early mobilization, a program of breathing exercises and diuretics) or continuous positive airway pressure in addition to standard treatment. Continuous positive airway pressure was administered 3 times a day for 2 consecutive days. Every cycle lasted 1 to 3 hours. All patients completed their 1-year follow-up. Data were analyzed according to the intention-to-treat principle.
  
  
  RESULTS
  The primary endpoint was the number of patients with PaO2/FIO2<200 48 hours after randomization. Continuous positive airway pressure use was associated with a statistically significant reduction in the number of patients with PaO2/FIO2<200 (4/33 [12%] v 14/31 [45%], p = 0.003). One patient in the control group died at the 30-day follow-up.
  
  
  CONCLUSIONS
  Among patients with acute respiratory failure following cardiac surgery, administration of continuous positive airway pressure in the main ward was associated with improved respiratory outcome. This was the first study that was performed in the main ward of post-surgical patients with acute respiratory failure.
authors: Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Luigi
authors: L
authors: Olper
authors: Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Elena
authors: E
authors: Bignami
authors: Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Ambra L
authors: AL
authors: Di Prima
authors: Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Santina
authors: S
authors: Albini
authors: Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Simona
authors: S
authors: Nascimbene
authors: Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Luca
authors: L
authors: Cabrini
authors: Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.
authors: Giovanni
authors: G
authors: Landoni
authors: Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
authors: Ottavio
authors: O
authors: Alfieri
mesh_terms: D000208:Acute Disease; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D010313:Partial Pressure; D019095:Point-of-Care Systems; D011182:Postoperative Care / Q000379:methods; D012131:Respiratory Insufficiency / Q000097:blood / Q000209:etiology / Q000628:therapy*
chemical_list: D010100:Oxygen
keywords: anesthesia; cardiac surgery; noninvasive ventilation; postoperative care; respiratory therapy