Nasal continuous positive airway pressure -: A method to avoid endotracheal reintubation in postoperative high-risk patients with severe nonhypercapnic oxygenation failure

Objectives: To study whether nasal continuous positive airway pressure (nCPAP) improves pulmonary oxygen transfer and avoids reintubation in patients with severe nonhypercapnic oxygenation failure after major cardiac, vascular, or abdominal surgery. Design: Prospective international study. Setting: Surgical ICU of a university hospital, Patients: Twenty consecutive patients after thoracic, abdominal, or combined thoracoabdominal operations, in whom pulmonary oxygen transfer deteriorated continuously following elective extubation after initial mechanical ventilation, Respiratory failure was due to atelectasis and/or left heart failure, and all patients met predefined criteria for reintubation. Interventions: nCPAP therapy (8 to 10 cm H2O) was initiated if PaO2 had decreased to < 80 mm Hg despite application of 100% oxygen (flow, 25 L/min), intermittent mask continuous positive airway pressure, and maximum conventional therapy. Measurements and results: nCPAP treatment was started 24.1 +/- 3.4 h after elective extubation, PaO2 was < 80 mm Hg in all patients, in 13 patients it was < 60 mm Hg, and in 3 patients it was < 50 mm Hg. Mean PaO2/fraction of inspired oxygen (FIO2) ratio had decreased to 60 +/- 2.6, and increased within the first hour of nCPAP to 136 +/- 12 (p < 0.001). The clinical condition in all patients improved further, and after 35.2 +/- 6.3 h, all patients were well oxygenated by face mask at ambient pressure (PaO2/FIO2 ratio, 146 +/- 14). Two patients were reintubated for reasons unrelated to oxygenation or ventilation (data are presented as mean +/- SEM). Conclusions: nCPAP is safe, easy to apply, and effective to improve arterial blood oxygenation in <1 h in postoperative patients with sec ere nonhypercapnic oxygenation failure. In these patients, who otherwise would have been reintubated, nCPAP can avoid endotracheal reintubation and mechanical ventilation.