NONINVASIVE NASAL MASK BIPAP MANAGEMENT FOR PROLONGED RESPIRATORY-FAILURE FOLLOWING CARDIOVASCULAR-SURGERY

The purpose of this study was to assess the efficacy of nasal mask bi- level positive airway pressure (BiPAP) support in managing respiratory failure following cardiovascular surgery. A total of 20 patients requ iring postoperative prolonged respiratory support of 72 hours or longe r were studied. BiPAP support was used for eight patients (BiPAP group ); the other 12 patients were managed using ordinary oxygen mask treat ment (control group). The mean age of the BiPAP group and control grou p was 65 and 58 years of age, respectively. The mean period of postope rative endotracheal intubation of the BiPAP group and control group wa s 12 +/- 5 days and 7 +/- 1 days, respectively. Reintubation was neces sary in two patients of the control group. The BiPAP group patients re quired no reintubation. BiPAP support was discontinued within 48 hours in 6 out of 8 patients. The respiratory rates of control group increa sed (p < 0.1) 24 hours after extubation, however, the respiratory rate s of the BiPAP group remained unchanged. The values of the respiratory index of the BiPAP group improved significantly (p < 0.01) after BiPA P management (from 1.5 +/- 0.2 to 0.9 +/- 0.2). The values of the cont rol group, however, remained unchanged. A-aDO(2) and Qs/Qt decreased ( p < 0.1) in the BiPAP group. There were no significant differences in central venous pressure or circulatory status between the two groups. In conclusion, BiPAP support is a noninvasive management technique for postoperative respiratory failure and may also prevent prolonged endo tracheal intubation.