Nasal Continuous Positive Airway Pressure : A Method to Avoid Endotracheal Reintubation in Postoperative High-risk Patients With Severe Nonhypercapnic Oxygenation Failure

摘要

Objectives: To study whether nasal continuous positive airway pressure (nCPAP) improvesnpulmonary oxygen transfer and avoids reintubation in patients with severe nonhypercapnicnoxygenation failure after major cardiac, vascular, or abdominal surgery.nDesign: Prospective interventional study.nSetting: Surgical ICU of a university hospital.nPatients: Twenty consecutive patients after thoracic, abdominal, or combined thoracoabdominalnoperations, in whom pulmonary oxygen transfer deteriorated continuously following electivenextubation after initial mechanical ventilation. Respiratory failure was due to atelectasis and/ornleft heart failure, and all patients met predefined criteria for reintubation.nInterventions: nCPAP therapy (8 to 10 cm H2O) was initiated if PaO2 had decreased to < 80 mmnHg despite application of 100% oxygen (flow, 25 L/min), intermittent mask continuous positivenairway pressure, and maximum conventional therapy.nMeasurements and results: nCPAP treatment was started 24.1 6 3.4 h after elective extubation.nPaO2 was < 80 mm Hg in all patients, in 13 patients it was < 60 mm Hg, and in 3 patients it wasn< 50 mm Hg. Mean PaO2/fraction of inspired oxygen (FIO2) ratio had decreased to 60 6 2.6, andnincreased within the first hour of nCPAP to 136 6 12 (p < 0.001). The clinical condition in allnpatients improved further, and after 35.2 6 6.3 h, all patients were well oxygenated by face masknat ambient pressure (PaO2/FIO2 ratio, 146 6 14). Two patients were reintubated for reasonsnunrelated to oxygenation or ventilation (data are presented as mean 6 SEM).nConclusions: nCPAP is safe, easy to apply, and effective to improve arterial blood oxygenation inn< 1 h in postoperative patients with severe nonhypercapnic oxygenation failure. In thesenpatients, who otherwise would have been reintubated, nCPAP can avoid endotracheal reintuba-ntion and mechanical ventilation.