Perioperative management
Effect of adding postoperative noninvasive ventilation to usual care to prevent pulmonary complications in patients undergoing coronary artery bypass grafting: A randomized controlled trial

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Objective

We compared the efficacy of noninvasive ventilation with bilevel positive airway pressure added to usual care versus usual care alone in patients undergoing coronary artery bypass grafting.

Methods

We performed a 2-group, parallel, randomized controlled trial. The primary outcome was time until fit for discharge. Secondary outcomes were partial pressure of carbon dioxide, forced expiratory volume in 1 second, atelectasis, adverse events, duration of intensive care stay, and actual postoperative stay.

Results

A total of 129 patients were randomly allocated to bilevel positive airway pressure (66) or usual care (63). Three patients allocated to bilevel positive airway pressure withdrew. The median duration of bilevel positive airway pressure was 16 hours (interquartile range, 11-19). The median duration of hospital stay until fit for discharge was 5 days for the bilevel positive airway pressure group (interquartile range, 4-6) and 6 days for the usual care group (interquartile range, 5-7; hazard ratio, 1.68; 95% confidence interval, 1.08-2.31; P = .019). There was no significant difference in duration of intensive care, actual postoperative stay, and mean percentage of predicted forced expiratory volume in 1 second on day 3. Mean partial pressure of carbon dioxide was significantly reduced 1 hour after bilevel positive airway pressure application, but there was no overall difference between the groups up to 24 hours. Basal atelectasis occurred in 15 patients (24%) in the usual care group and 2 patients (3%) in the bilevel positive airway pressure group. Overall, 30% of patients in the bilevel positive airway pressure group experienced an adverse event compared with 59% in the usual care group.

Conclusions

Among patients undergoing elective coronary artery bypass grafting, the use of bilevel positive airway pressure at extubation reduced the recovery time. Supported by trained staff, more than 75% of all patients allocated to bilevel positive airway pressure tolerated it for more than 10 hours.

CTSNet classification

21
23.1
23.1.4

Abbreviations and Acronyms

BLPAP
bilevel positive airway pressure
BMI
body mass index
CABG
coronary artery bypass grafting
CI
confidence interval
CICU
cardiac intensive care unit
CPAP
continuous positive airway pressure
FEV1
forced expiratory volume in 1 second
FFD
fit for discharge
ICU
intensive care unit
IQR
interquartile range
NIPSV
noninvasive pressure support ventilation
NIV
noninvasive ventilation
Paco2
partial pressure of carbon dioxide
PPT
postoperative physical therapy
SD
standard deviation

Cited by (0)

The equipment for the BLPAP used in the study was donated by Philips Respironics (Chichester, UK). The study was partly supported by the National Institute for Health Research Bristol Cardiovascular Biomedical Research Unit. Neither Philips Healthcare nor the National Institute for Health Research had any role in the design, conduct, analysis, or reporting of the trial. The trial was sponsored by Imperial College London. The trial was designed, conducted, analyzed, and interpreted independently of the sponsor. The authors had full access to the data and are responsible for submitting the publication. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute of Health Research, or the Department of Health.

Disclosures: Authors have nothing to disclose with regard to commercial support.