Education and Research Department, National Institute of Cardiology, Rio de Janeiro, Brazil.
Physiotherapy Service, National Institute of Cardiology, Rio de Janeiro, Brazil.
Ann Med. 2024 Dec;56(1):2394848. doi: 10.1080/07853890.2024.2394848. Epub 2024 Aug 28.
The postoperative (PO) period after cardiac surgery is associated with the occurrence of respiratory complications. Noninvasive positive pressure ventilation (NIPPV) is largely used as a ventilatory support strategy after the interruption of invasive mechanical ventilation. However, the variables associated with NIPPV prescription are unclear.
To describe the literature on predictors of NIPPV prescription in patients during the PO period of cardiac surgery.
This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform in December 2021 (CRD42021291973). Bibliographic searches were performed in February 2022 using the PubMed, Lilacs, Embase and PEDro databases, with no year or language restrictions. The Predictors for the prescription of NIPPV were considered among patients who achieved curative NIPPV.
A total of 349 articles were identified, of which four were deemed eligible and were included in this review. Three studies were retrospective studies, and one was a prospective safety pilot study. The total sample size in each study ranged from 109 to 1657 subjects, with a total of 3456 participants, of whom 283 realized NIPPV. Curative NIPPV was the only form of NIPPV in 75% of the studies, which presented this form of prescription in 5-9% of the total sample size, with men around 65 years old being the majority of the participants receiving curative NIPPV. The main indication for curative NIPPV was acute respiratory failure. Only one study realized prophylactic NIPPV (28% of 32 participants). The main predictors for the prescription of curative NIPPV in the PO period of cardiac surgery observed in this study were elevated body mass index (BMI), hypercapnia, PO lung injury, cardiogenic oedema and pneumonia.
BMI and lung alterations related to gas exchange disturbances are major predictors for NIPPV prescription in patients during the PO period of cardiac surgery. The identification of these predictors can benefit clinical decision-making regarding the prescription of NIPPV and help conserve human and material resources, thereby preventing the indiscriminate use of NIPPV.
心脏手术后的术后（PO）期与发生呼吸并发症有关。非侵入性正压通气（NIPPV）在中断侵入性机械通气后通常被用作通气支持策略。然而，与 NIPPV 处方相关的变量尚不清楚。
描述心脏手术后 PO 期患者 NIPPV 处方的文献。
本系统评价于 2021 年 12 月在国际前瞻性系统评价登记处（PROSPERO）平台上注册（CRD42021291973）。2022 年 2 月，使用 PubMed、Lilacs、Embase 和 PEDro 数据库进行文献检索，无年份和语言限制。在实现治愈性 NIPPV 的患者中，考虑了 NIPPV 处方的预测因素。
共确定了 349 篇文章，其中 4 篇被认为符合条件并包含在本综述中。三项研究为回顾性研究，一项为前瞻性安全试点研究。每项研究的总样本量从 109 到 1657 例不等，共 3456 名参与者，其中 283 名实现了 NIPPV。治愈性 NIPPV 是 75%研究中的唯一形式的 NIPPV，在总样本量的 5-9%中呈现这种处方形式，其中约 65 岁的男性是接受治愈性 NIPPV 的大多数参与者。治愈性 NIPPV 的主要指征是急性呼吸衰竭。只有一项研究实现了预防性 NIPPV（32 名参与者中的 28%）。本研究观察到心脏手术后 PO 期 NIPPV 处方的主要预测因素是升高的体重指数（BMI）、高碳酸血症、PO 肺损伤、心源性水肿和肺炎。
与气体交换障碍相关的 BMI 和肺部改变是心脏手术后 PO 期患者 NIPPV 处方的主要预测因素。这些预测因素的识别可以有助于临床决策制定 NIPPV 处方，并有助于节约人力和物力资源，从而防止 NIPPV 的滥用。
