Failure Factors of Noninvasive Positive Pressure Ventilation for Hypoxemia after Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

RENHai-bo ,  LIUBin , LIYing , WEIYu , XIAOHong-yan

Intensive Care Unit, Wuhan Asia Heart Hospital, Wuhan 430022, P. R. China;

Corresponding author：

LIUBin, Email: liubin02161@sina.com

Keywords：

Noninvasive positive pressure ventilation; Hypoxemia; Simplified acute physiology scoreⅡ; Pneumonia

DOI：

10.7507/1007-4848.20160213

Video：

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Objective To explore the reason of failure in noninvasive positive pressure ventilation (NPPV) for treatment of postoperative hypoxemia, in order to better guide use of NPPV after cardiac surgery. Methods We retrospectively analyzed the clinical data of 64 patients after heart surgery with undergoing NPPV treatment due to hypoxemia in our hospital between January 2012 and December 2013 year.There were 49 males and 15 females at age of 28 to 87 years. There were 17 patients with NPPV failure. The related factors for failure of NPPV were analyzed. Results Factors associated with failure of NPPV included smoking history, preoperative pulmonary function abnormalities, blood transfusion amount > 1 000 ml, simplified acute physiology score Ⅱ(SAPS Ⅱ) before NPPV > 35 points, oxygenation index (PaO₂/FiO₂) < 100 mm Hg before NPPV, PaO₂/FiO₂ < 150 mm Hg after NPPV treatment for 1 h, mechanical ventilation time > 72 h at the first time, and pneumonia (P < 0.05). The SAPS Ⅱ > 35 points before NPPV and pneumonia were the independent risk factors for NPPV treatment failure for postoperative hypoxemia. Conclusion Postoperative NPPV for heart disease should be according to the cause of low oxygen and severity. For patients with SAPS less than 35 points before NPPV or patients with pneumonia, NPPV should not be used. In the process of NPPV, if clinical effect is not satisfied, it should be converted to invasive ventilation immediately.

Citation： RENHai-bo, LIUBin, LIYing, WEIYu, XIAOHong-yan. Failure Factors of Noninvasive Positive Pressure Ventilation for Hypoxemia after Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(9): 889-893. doi: 10.7507/1007-4848.20160213 Copy

1.	Koutsogiannidis Charilaos-Panagiotis C, Ananiadou Olga G. Tailoring noninvasive ventilation management in non-ICU settings and the cardiac surgery context. Respir Care, 2014, 59(2):303-304.
2.	Giovanni L, Alberto Z, Luca C. Noninvasive ventilation after cardiac and thoracic surgery in adult patients:a review. J Cardiothorac Vasc Anesth, 2012, 26(5):9, 17-22.
3.	张梁, 姜涛.胸外科手术后影响急性呼吸窘迫综合发生的高危因素与治疗.中国胸心血管外科临床杂志, 2010, 17(1): 55-59.
4.	Onorati F, Santini F, Mariscalco G, et al. Leukocyte filtration ameliorates the inflammatory response in patients with mild to moderate lung dysfunction. Ann Thorac Surg, 2011, 92(1):111-121.
5.	王红, 贾明, 李呈龙, 等.头罩持续气道内正压治疗体外循环心脏手术拔除气管插管后低氧血症初探.中国体外循环杂志, 2014, 12(2):92-95.
6.	Lim CH1, Nam MJ, Lee JS, et al. A meta-analysis of pulmonary function with pulsatile perfusion in cardiac surgery. Artif Organs, 2015, 39(2):110-117.
7.	谢波, 薛松, 徐根兴, 等.序贯无创通气在冠状动脉旁路移植术后机械通气撤机中的应用.中国胸心血管外科临床杂志, 2010, 17(3):206-210.
8.	Morimoto K, Nishimura K, Miyasaka S, et al. The effect of sivelestat sodium hydrate on severe respiratory failure after thoracic aortic surgery with deep hypothermia. Ann Thorac Cardiovasc Surg, 2011, 17(4):369-375.
9.	尚云波, 李嘉嘉, 孙海燕, 等.有创呼吸机实施无创正压通气与常规吸氧治疗急性心源性肺水肿的对比研究.中国急救医学, 2012, 32(11):1037-1040.
10.	García-Delgado M, Navarrete I, García-Palma MJ, et al. Postoperative respiratory failure after cardiac surgery:use of noninvasive ventilation. J Cardiothorac Vasc Anesth, 2012, 26(3):443-447.
11.	Antonelli M, Conti G, Moro ML, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemie respiratory failure:a multi-centre study. Intensive Care Med, 2001, 27:1718-1728.
12.	张鑫, 王慧娟, 磨国鑫, 等.无创正压通气治疗免疫抑制合并急性呼吸衰竭患者的临床分析.中国危重病急救医学, 2011, 23(9):530-533.
13.	韩芳, 江宇泳, 郑建红, 等.严重急性呼吸窘迫综合征所致呼吸衰竭及无创通气治疗.中华结核和呼吸杂志, 2004, 27(9):593-597.
14.	De Santo LS, Bancone C, Santarpino G, et al. Noninvasive positive-pressure ventilation for extubation failure after cardiac surgery:Pilot safety evaluation. J Thorac Cardiovasc Surg, 2009, 137(2):342-346.
15.	Kurt M, Boeken U, Litmathe J, et al. Oxygenation failure after cardiac surgery:early re-intubation versus treatment by nasal continuous positive airway pressure(NCPAP)or non-invasive positive pressure ventilation(NPPV). Monaldi Arch Chest Dis, 2008, 70(2):71-75.
16.	丁琳, 詹庆元, 罗祖金, 等.无创正压通气治疗急性呼吸窘迫综合征的前瞻性队列研究.中国危重病急救医学, 2009, 21(10):613-616.
17.	Murad A, Li P Z, Dial S, et al. The role of noninvasive positive pressure ventilation in community-acquired pneumonia. J Crit Care, 2015, 30(1):49-54.
18.	van Gemert JP, Brijker F, Witten MA, et al. Intubation after noninvasive ventilation failure in chronic obstructive pulmonary disease:associated factors at emergency department presentation. Eur J Emerg Med, 2015, 22 (1):49-54.
19.	孙建萍, 仲维佳, 卢家凯, 等.非心脏手术患者围术期大量输血后发生急性肺损伤/急性呼吸窘迫综合征的危险因素及预后分析.心肺血管病杂志, 2014, 33(1):76-80.
20.	Ware LB, Matthay MA. The acute respiratory distress syndrome.N Engl J Med, 2000, 342(18):1334-1349.
21.	Declaux C, L'Her E, Alberti C, et al. Treatment of acute hypoxemie nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask:a randomized controlled trial. JAMA, 2000, 284:2352-2360.
22.	龚倩, 葛建军, 葛圣林, 等.无创正压通气在体外循环术后急性呼吸衰竭患者中的应用.中国循环杂志, 2012, 27(3):212-215.
23.	Sağıroğlu G, Baysal A, Copuroğlu E, et al. Does early use of bilevel positive airway pressure (bipap) in cardiothoracic intensive care unit prevent reintubation?. Int J Clin Exp Med, 2014, 7(10):3439-3446.
24.	徐远达, 江梅, 萧正伦.无创通气辅助治疗严重急性呼吸综合征急性呼吸衰竭的回顾分析.中国呼吸与危重监护杂志, 2010, 9(6):575-579.
25.	何为群, 桑岭, 刘晓青, 等.无创机械通气在胸腺切除术后肌无力危象患者中的应用.中国呼吸与危重监护杂志, 2014, 13(3):250-253.
26.	Raman V, MacGlaflin CE, Erkmen CP. Noninvasive positive pressure ventilation following esophagectomy:safety demonstrated in a pig model. Chest, 2015, 147(2):356-361.

1. Koutsogiannidis Charilaos-Panagiotis C, Ananiadou Olga G. Tailoring noninvasive ventilation management in non-ICU settings and the cardiac surgery context. Respir Care, 2014, 59(2):303-304.
2. Giovanni L, Alberto Z, Luca C. Noninvasive ventilation after cardiac and thoracic surgery in adult patients:a review. J Cardiothorac Vasc Anesth, 2012, 26(5):9, 17-22.
3. 张梁, 姜涛.胸外科手术后影响急性呼吸窘迫综合发生的高危因素与治疗.中国胸心血管外科临床杂志, 2010, 17(1): 55-59.
4. Onorati F, Santini F, Mariscalco G, et al. Leukocyte filtration ameliorates the inflammatory response in patients with mild to moderate lung dysfunction. Ann Thorac Surg, 2011, 92(1):111-121.
5. 王红, 贾明, 李呈龙, 等.头罩持续气道内正压治疗体外循环心脏手术拔除气管插管后低氧血症初探.中国体外循环杂志, 2014, 12(2):92-95.
6. Lim CH1, Nam MJ, Lee JS, et al. A meta-analysis of pulmonary function with pulsatile perfusion in cardiac surgery. Artif Organs, 2015, 39(2):110-117.
7. 谢波, 薛松, 徐根兴, 等.序贯无创通气在冠状动脉旁路移植术后机械通气撤机中的应用.中国胸心血管外科临床杂志, 2010, 17(3):206-210.
8. Morimoto K, Nishimura K, Miyasaka S, et al. The effect of sivelestat sodium hydrate on severe respiratory failure after thoracic aortic surgery with deep hypothermia. Ann Thorac Cardiovasc Surg, 2011, 17(4):369-375.
9. 尚云波, 李嘉嘉, 孙海燕, 等.有创呼吸机实施无创正压通气与常规吸氧治疗急性心源性肺水肿的对比研究.中国急救医学, 2012, 32(11):1037-1040.
10. García-Delgado M, Navarrete I, García-Palma MJ, et al. Postoperative respiratory failure after cardiac surgery:use of noninvasive ventilation. J Cardiothorac Vasc Anesth, 2012, 26(3):443-447.
11. Antonelli M, Conti G, Moro ML, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemie respiratory failure:a multi-centre study. Intensive Care Med, 2001, 27:1718-1728.
12. 张鑫, 王慧娟, 磨国鑫, 等.无创正压通气治疗免疫抑制合并急性呼吸衰竭患者的临床分析.中国危重病急救医学, 2011, 23(9):530-533.
13. 韩芳, 江宇泳, 郑建红, 等.严重急性呼吸窘迫综合征所致呼吸衰竭及无创通气治疗.中华结核和呼吸杂志, 2004, 27(9):593-597.
14. De Santo LS, Bancone C, Santarpino G, et al. Noninvasive positive-pressure ventilation for extubation failure after cardiac surgery:Pilot safety evaluation. J Thorac Cardiovasc Surg, 2009, 137(2):342-346.
15. Kurt M, Boeken U, Litmathe J, et al. Oxygenation failure after cardiac surgery:early re-intubation versus treatment by nasal continuous positive airway pressure(NCPAP)or non-invasive positive pressure ventilation(NPPV). Monaldi Arch Chest Dis, 2008, 70(2):71-75.
16. 丁琳, 詹庆元, 罗祖金, 等.无创正压通气治疗急性呼吸窘迫综合征的前瞻性队列研究.中国危重病急救医学, 2009, 21(10):613-616.
17. Murad A, Li P Z, Dial S, et al. The role of noninvasive positive pressure ventilation in community-acquired pneumonia. J Crit Care, 2015, 30(1):49-54.
18. van Gemert JP, Brijker F, Witten MA, et al. Intubation after noninvasive ventilation failure in chronic obstructive pulmonary disease:associated factors at emergency department presentation. Eur J Emerg Med, 2015, 22 (1):49-54.
19. 孙建萍, 仲维佳, 卢家凯, 等.非心脏手术患者围术期大量输血后发生急性肺损伤/急性呼吸窘迫综合征的危险因素及预后分析.心肺血管病杂志, 2014, 33(1):76-80.
20. Ware LB, Matthay MA. The acute respiratory distress syndrome.N Engl J Med, 2000, 342(18):1334-1349.
21. Declaux C, L'Her E, Alberti C, et al. Treatment of acute hypoxemie nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask:a randomized controlled trial. JAMA, 2000, 284:2352-2360.
22. 龚倩, 葛建军, 葛圣林, 等.无创正压通气在体外循环术后急性呼吸衰竭患者中的应用.中国循环杂志, 2012, 27(3):212-215.
23. Sağıroğlu G, Baysal A, Copuroğlu E, et al. Does early use of bilevel positive airway pressure (bipap) in cardiothoracic intensive care unit prevent reintubation?. Int J Clin Exp Med, 2014, 7(10):3439-3446.
24. 徐远达, 江梅, 萧正伦.无创通气辅助治疗严重急性呼吸综合征急性呼吸衰竭的回顾分析.中国呼吸与危重监护杂志, 2010, 9(6):575-579.
25. 何为群, 桑岭, 刘晓青, 等.无创机械通气在胸腺切除术后肌无力危象患者中的应用.中国呼吸与危重监护杂志, 2014, 13(3):250-253.
26. Raman V, MacGlaflin CE, Erkmen CP. Noninvasive positive pressure ventilation following esophagectomy:safety demonstrated in a pig model. Chest, 2015, 147(2):356-361.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Failure Factors of Noninvasive Positive Pressure Ventilation for Hypoxemia after Cardiac Surgery

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