Elective nasal continuous positive airway pressure to support respiration after prolonged ventilation in infants after congenital cardiac surgery.
BACKGROUND
We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery.


METHODS
In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured.


RESULTS
After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P< 0.0001), PO2(mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P< 0.0001), and PCO2(mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P< 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation.


CONCLUSIONS
NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation.
Department of Anesthesia, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India.
Hemang
H
Gandhi
Department of Cardiovascular Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India.
Amit
A
Mishra
Department of Anesthesia, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India.
Rajesh
R
Thosani
Department of Research, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India.
Himanshu
H
Acharya
Department of Anesthesia, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India.
Ritesh
R
Shah
Department of Pediatric Critical Care, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India.
Jigar
J
Surti
Department of Anesthesia, U. N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Ahmedabad, Gujarat, India.
Alpesh
A
Sarvaia
Congenital cardiac surgery; infants; nasal continuous positive airway pressure; oxygen mask