JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Pasquina, P. Articles by Ricou, B. Search for Related Content PubMed PubMed Citation Articles by Pasquina, P. Articles by Ricou, B. Related Collections Cardiovascular Critical Care Heart Complications

---

CARDIOVASCULAR ANESTHESIA

Continuous Positive Airway Pressure Versus Noninvasive Pressure Support Ventilation to Treat Atelectasis After Cardiac Surgery

Patrick Pasquina, RN^*, Paolo Merlani, MD, Jean Max Granier, RN^*, and Bara Ricou, MD

*Respiratory Therapy Unit of the Division of Surgical Intensive Care, Division of Surgical Intensive Care, Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospital, Geneva, Switzerland

Address correspondence and reprint requests to Paolo Merlani, MD, Division des Soins Intensifs de Chirurgie, Département APSIC, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland. Address e-mail to paolo.merlani{at}hcuge.ch

Atelectasis is common after cardiac surgery and may result in impaired gas exchange. Continuous positive airway pressure (CPAP) is often used to prevent or treat postoperative atelectasis. We hypothesized that noninvasive pressure support ventilation (NIPSV) by increasing tidal volume could improve the evolution of atelectasis more than CPAP. One-hundred-fifty patients admitted to our surgical intensive care unit (SICU) with a Radiological Atelectasis Score 2 after cardiac surgery were randomly assigned to receive either CPAP or NIPSV four times a day for 30 min. Positive end-expiratory pressure was set at 5 cm H₂O in both groups. In the NIPSV group, pressure support was set to provide a tidal volume of 8–10 mL/kg. At SICU discharge, we observed an improvement of the Radiological Atelectasis Score in 60% of the patients with NIPSV versus 40% of those receiving CPAP (P = 0.02). There was no difference in oxygenation (PaO₂/fraction of inspired oxygen at SICU discharge: 280 ± 38 in the CPAP group versus 301 ± 40 in the NIPSV group), pulmonary function tests, or length of stay. Minor complications, such as gastric distensions, were similar in the two groups. NIPSV was superior to CPAP regarding the improvement of atelectasis based on radiological score but did not confer any additional clinical benefit, raising the question of its usefulness for altering outcome.

IMPLICATIONS: This prospective, randomized, controlled study analyzing the treatment for atelectasis after cardiac surgery showed that noninvasive pressure support ventilation was superior to continuous positive airway pressure for improving atelectasis based on radiological score but did not confer any additional benefit, thus raising the question of its clinical usefulness.

This article has been cited by other articles:

				L. S. De Santo, C. Bancone, G. Santarpino, G. Romano, A. Della Corte, M. Vicchio, A. De Pietro, N. Galdieri, and M. Cotrufo Noninvasive positive-pressure ventilation for extubation failure after cardiac surgery: Pilot safety evaluation. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 342 - 346. [Abstract] [Full Text] [PDF]

				S. Celebi, O. Koner, F. Menda, O. Omay, I. Gunay, K. Suzer, and N. Cakar Pulmonary Effects of Noninvasive Ventilation Combined with the Recruitment Maneuver After Cardiac Surgery Anesth. Analg., August 1, 2008; 107(2): 614 - 619. [Abstract] [Full Text] [PDF]

				J. Garcia-Fernandez, G. Tusman, F. Suarez-Sipmann, J. Llorens, M. Soro, and J. F. Belda Programming Pressure Support Ventilation in Pediatric Patients in Ambulatory Surgery with a Laryngeal Mask Airway Anesth. Analg., December 1, 2007; 105(6): 1585 - 1591. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999