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.	張梁, 姜濤.胸外科手術后影響急性呼吸窘迫綜合發生的高危因素與治療.中國胸心血管外科臨床雜志, 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.	王紅, 賈明, 李呈龍, 等.頭罩持續氣道內正壓治療體外循環心臟手術拔除氣管插管后低氧血癥初探.中國體外循環雜志, 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.	謝波, 薛松, 徐根興, 等.序貫無創通氣在冠狀動脈旁路移植術后機械通氣撤機中的應用.中國胸心血管外科臨床雜志, 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, 孫海燕, 等.有創呼吸機實施無創正壓通氣與常規吸氧治療急性心源性肺水腫的對比研究.中國急救醫學, 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.	張鑫, 王慧娟, 磨國鑫, 等.無創正壓通氣治療免疫抑制合并急性呼吸衰竭患者的臨床分析.中國危重病急救醫學, 2011, 23(9):530-533.
13.	韓芳, 江宇泳, 鄭建紅, 等.嚴重急性呼吸窘迫綜合征所致呼吸衰竭及無創通氣治療.中華結核和呼吸雜志, 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, 詹慶元, 羅祖金, 等.無創正壓通氣治療急性呼吸窘迫綜合征的前瞻性隊列研究.中國危重病急救醫學, 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.	孫建萍, 仲維佳, 盧家凱, 等.非心臟手術患者圍術期大量輸血后發生急性肺損傷/急性呼吸窘迫綜合征的危險因素及預后分析.心肺血管病雜志, 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.	龔倩, 葛建軍, 葛圣林, 等.無創正壓通氣在體外循環術后急性呼吸衰竭患者中的應用.中國循環雜志, 2012, 27(3):212-215.
23.	Sa??ro?lu G, Baysal A, Copuro?lu 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.	徐遠達, 江梅, 蕭正倫.無創通氣輔助治療嚴重急性呼吸綜合征急性呼吸衰竭的回顧分析.中國呼吸與危重監護雜志, 2010, 9(6):575-579.
25.	何為群, 桑嶺, 劉曉青, 等.無創機械通氣在胸腺切除術后肌無力危象患者中的應用.中國呼吸與危重監護雜志, 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. 張梁, 姜濤.胸外科手術后影響急性呼吸窘迫綜合發生的高危因素與治療.中國胸心血管外科臨床雜志, 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. 王紅, 賈明, 李呈龍, 等.頭罩持續氣道內正壓治療體外循環心臟手術拔除氣管插管后低氧血癥初探.中國體外循環雜志, 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. 謝波, 薛松, 徐根興, 等.序貫無創通氣在冠狀動脈旁路移植術后機械通氣撤機中的應用.中國胸心血管外科臨床雜志, 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, 孫海燕, 等.有創呼吸機實施無創正壓通氣與常規吸氧治療急性心源性肺水腫的對比研究.中國急救醫學, 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. 張鑫, 王慧娟, 磨國鑫, 等.無創正壓通氣治療免疫抑制合并急性呼吸衰竭患者的臨床分析.中國危重病急救醫學, 2011, 23(9):530-533.
13. 韓芳, 江宇泳, 鄭建紅, 等.嚴重急性呼吸窘迫綜合征所致呼吸衰竭及無創通氣治療.中華結核和呼吸雜志, 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, 詹慶元, 羅祖金, 等.無創正壓通氣治療急性呼吸窘迫綜合征的前瞻性隊列研究.中國危重病急救醫學, 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. 孫建萍, 仲維佳, 盧家凱, 等.非心臟手術患者圍術期大量輸血后發生急性肺損傷/急性呼吸窘迫綜合征的危險因素及預后分析.心肺血管病雜志, 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. 龔倩, 葛建軍, 葛圣林, 等.無創正壓通氣在體外循環術后急性呼吸衰竭患者中的應用.中國循環雜志, 2012, 27(3):212-215.
23. Sa??ro?lu G, Baysal A, Copuro?lu 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. 徐遠達, 江梅, 蕭正倫.無創通氣輔助治療嚴重急性呼吸綜合征急性呼吸衰竭的回顧分析.中國呼吸與危重監護雜志, 2010, 9(6):575-579.
25. 何為群, 桑嶺, 劉曉青, 等.無創機械通氣在胸腺切除術后肌無力危象患者中的應用.中國呼吸與危重監護雜志, 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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