Postoperative noninvasive ventilation

Abstract

Backround: Patients with acute respiratory failure often require endotracheal intubation and mechanical ventilation. Non-invasive ventilation (NIV) means ventilation without an artificial airway - endotracheal tubus or tracheostomy canulla. The benefit of NIV is in avoiding the need for endotracheal intubation and its comorbidity, reducing morbidity, mortality and duration of hospitalisation and in its cost effectivness. Methods: At the surgical intensive care units of the University Medical Centre Ljubljana we analysed the treatment of acute postoperative respiratory failure with NIV and compared our results with world literature. Results: The retrospective study included 71 patients with acute postoperative respiratory failure, 39 male and 32 female, mean age 70 years. Hypoxemic acute respiratory failure was observed in 29 (40 %) patients, hypercapnic type in 42 (60 %) patients. With CPAP (continuous positive airway pressure) masks, and with helmets in 18 cases, we improved respiratory insufficiency in 46 (65 %) patients. During treatment the percentage of inhaled oxygen was gradually reduced. Carrico index (PaO2 / FiO2) was significantly greater (before NIV 158 ± 91, after NIV 239 ± 95, p = 0,05) and PaO2 raised from 9,2 ± 2,5kPa to 11,7 ± 3,3kPa (p = 0,05). The values of PaCO2 fell insignificantly (p = 0,46). 25 (35 %) patients were intubated and transported to an intensive therapy unit. Conclusions: NIV has proven to be an effective therapy in patients with acute and chronic respiratory failure in strategy to reduce intubation rates with entailed comorbidity, the duration of hospital stays as well as morbidity and motrality rates. Our results with NIV therapy in postoperative respiratory failure were successfull in 65 %, and are comparable with results from literature.