心脏手术后预防性鼻持续气道正压通气可预防术后肺部并发症：一项针对500例患者的前瞻性、随机、对照试验。

Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients.

作者信息

Zarbock Alexander, Mueller Eckhard, Netzer Sabine, Gabriel Andrea, Feindt Peter, Kindgen-Milles Detlef

机构信息

Department of Anesthesiology and Critical Care Medicine, University of Muenster, Muenster, Germany.

Department of Anesthesiologie, Intensive Care, and Pain Therapy, Knappschaftskrankenhaus Langendreer-University Hospital, Bochum, Germany.

出版信息

Chest. 2009 May;135(5):1252-1259. doi: 10.1378/chest.08-1602. Epub 2008 Nov 18.

DOI:10.1378/chest.08-1602

PMID:19017864

Abstract

BACKGROUND

Continuous positive airway pressure is a noninvasive respiratory support technique that may prevent pulmonary complications following cardiac surgery. This study was conducted to determine the efficacy of prophylactic nasal continuous positive airway pressure (nCPAP) compared with standard treatment. The primary end points were pulmonary adverse effects defined as hypoxemia (Pao(2)/fraction of inspired oxygen [Fio(2)] <100), pneumonia, and reintubation. The secondary end point was the readmission rate to the ICU or intermediate care unit (IMCU).

METHODS

We prospectively randomized 500 patients scheduled for elective cardiac surgery. Following extubation either in the operating room (early) or in the ICU (late), patients were allocated to standard treatment (control) including 10 min of intermittent nCPAP at 10 cm H(2)O every 4 h or prophylactic nCPAP (study) at an airway pressure of 10 cm H(2)O for at least 6 h.

RESULTS

Prophylactic nCPAP significantly improved arterial oxygenation (Pao(2)/Fio(2)) without altering heart rate and mean arterial BP. Pulmonary complications including hypoxemia (defined as Pao(2)/Fio(2) <100), pneumonia, and reintubation rate were reduced in study patients compared to controls (12 of 232 patients vs 25 of 236 patients, respectively; p = 0.03). The readmission rate to the ICU or IMCU was significantly lower in nCPAP-treated patients (7 of 232 patients vs 14 of 236 patients, respectively; p = 0.03).

CONCLUSIONS

The long-term administration of prophylactic nCPAP following cardiac surgery improved arterial oxygenation, reduced the incidence of pulmonary complications including pneumonia and reintubation rate, and reduced readmission rate to the ICU or IMCU. Thus noninvasive respiratory support with nCPAP is a useful tool to reduce pulmonary morbidity following elective cardiac surgery.

摘要

背景

持续气道正压通气是一种无创呼吸支持技术，可能预防心脏手术后的肺部并发症。本研究旨在确定预防性鼻持续气道正压通气（nCPAP）与标准治疗相比的疗效。主要终点是定义为低氧血症（动脉血氧分压/吸入氧分数[Pao₂/Fio₂]<100）、肺炎和再次插管的肺部不良反应。次要终点是入住重症监护病房（ICU）或中级护理单元（IMCU）的再入院率。

方法

我们对500例计划进行择期心脏手术的患者进行前瞻性随机分组。在手术室（早期）或ICU（晚期）拔管后，患者被分配至标准治疗（对照组），包括每4小时进行10分钟10 cm H₂O的间歇性nCPAP，或气道压力为10 cm H₂O的预防性nCPAP（研究组），持续至少6小时。

结果

预防性nCPAP显著改善了动脉氧合（Pao₂/Fio₂），而不改变心率和平均动脉血压。与对照组相比，研究组患者的肺部并发症包括低氧血症（定义为Pao₂/Fio₂<100）、肺炎和再次插管率均有所降低（分别为232例患者中的12例和236例患者中的25例；p = 0.03）。nCPAP治疗的患者入住ICU或IMCU的再入院率显著更低（分别为232例患者中的7例和236例患者中的14例；p = 0.03）。