Prolonged use of noninvasive positive pressure ventilation after extubation among patients in the intensive care unit following cardiac surgery: The predictors and its impact on patient outcome

• Published in: Scientific reports 2019-07, Vol.9 (1), p.9539-10, Article 9539
• Main Authors: Chen, Pei-Ku, Shih, Chun-Che, Lin, Fang-Chi, Perng, Diahn-Warng, Chou, Kun-Ta, Kou, Yu Ru, Ko, Hsin-Kuo
• Format: Article
• Language: English
• Subjects: 692/308; 692/499; Aged; Airway Extubation; Cardiac Surgical Procedures; Comorbidity; Critical Care - methods; Duration of Therapy; Extubation; Female; Heart; Heart Function Tests; Heart surgery; Humanities and Social Sciences; Humans; Intensive care; Intensive Care Units; Kaplan-Meier Estimate; Kidney diseases; Male; Mechanical ventilation; Middle Aged; multidisciplinary; Odds Ratio; Patient Outcome Assessment; Patients; Positive-Pressure Respiration - adverse effects; Positive-Pressure Respiration - methods; Postoperative Care; Pressure; Risk Factors; Science; Science (multidisciplinary); Ventilators
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-019-45881-x

This retrospective, observational cohort study aimed to determine the independent risk factors and impact of prolonged non-invasive positive pressure ventilation (NIPPV) after extubation among patients in the intensive care unit following cardiac surgery. Patients who received prophylactic NIPPV after extubation were categorized into prolonged (NIPPV duration >3 days, n = 83) and non-prolonged groups (NIPPV duration ≤3 days, n = 105). The perioperative characteristics and hospital outcomes were recorded. The multivariate analyses identified the preoperative residual volume/total lung capacity (RV/TLC) ratio (adjusted odds ratio [AOR]: 1.10; 95% CI:1.01–1.19, p  = 0.022) and postoperative acute kidney injury (AKI) with Kidney Disease Improving Global Outcomes (KDIGO) stage 2–3, 48 h after surgery (AOR: 3.87; 95% CI:1.21–12.37, p  = 0.023) as independent predictors of prolonged NIPPV. Patients with both RV/TLC ratio > 46.5% and KDIGO stage 2–3 showed a highly increased risk of prolonged NIPPV (HR 27.17, p  = 0.010), which was in turn associated with higher risk of postoperative complications and prolonged ICU and hospital stays. Preoperative RV/TLC ratio and postoperative AKI could identify patients at higher risk for prolonged NIPPV associated with poor outcomes. These findings may allow early recognition of patients who are at a higher risk for prolonged NIPPV, and help refine the perioperative management and critical care.