Does early use of bilevel positive airway pressure (bipap) in cardiothoracic intensive care unit prevent reintubation?

INTRODUCTION

Non-invasive ventilation (NIV) is a preferred treatment in acute respiratory failure after operations. Our aim is to investigate the success of early use of bilevel positive airway pressure (BIPAP) after cardiac or thoracic surgeries to prevent reintubation.

METHODS

In a prospective randomized study, 254 patients were divided into two groups depending on the time period between extubation and the application of BIPAP. In Group 1 BIPAP was applied after extubation within 48 hours after surgery following fulfilling of acute respiratory failure criterias whereas, in Group 2, BIPAP was applied one hour after extubation for two episodes of 20 minute duration and 3 hours apart. Arterial blood gas values (pH, PaO2, PaCO2) at first and fourth hour after BIPAP were collected.

RESULTS

In comparison between groups, no significant differences were observed for arterial blood gas values of pH and PaCO2 at baseline, one and four hours after BIPAP (p > 0.05) however, the PaO2 values at one and four hours after BIPAP were significantly better in Group 1 in comparison to Group 2 (p < 0.001, p < 0.001; respectively). Reintubation rate was 14 patients (11%) in Group 1 and 7 patients (5.5%) in Group 2 (p = 0.103).

CONCLUSIONS

The early and prophylactic use of BIPAP after cardiac or thoracic operations did not provide diminished rates in the postoperative complications such as reintubation.