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Effectiveness of prophylactic non-invasive ventilation on respiratory function in the postoperative phase of
Camilla R S Silva1, Lívia B Andrade1, Danielle A S X Maux1
1Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brazil.
Insights
Prophylactic non-invasive ventilation (NIV) using continuous positive airway pressure (CPAP) improved peak expiratory flow in children post-cardiac surgery. This safe intervention showed no significant impact on hospitalization or intensive care duration.
Area of Science:
- Pediatric critical care medicine
- Cardiothoracic surgery
- Respiratory physiology
Background:
- Post-operative respiratory complications are a concern in pediatric cardiac surgery.
- Non-invasive ventilation (NIV) may offer a prophylactic benefit in managing respiratory function after surgery.
Purpose of the Study:
- To assess the effectiveness of prophylactic non-invasive ventilation (NIV) on respiratory function in pediatric patients following cardiac surgery.
- To evaluate the impact of continuous positive airway pressure (CPAP) on lung function and clinical outcomes.
Main Methods:
- A randomized controlled trial involving 50 children aged 7-16 undergoing cardiac surgery.
- Patients received standard post-operative care or CPAP (10 cmH20) for 30 minutes twice daily from POD 1-5.
- Respiratory function was measured pre-operatively and on PODs 1, 3, and 5; hospitalization and intensive care durations were recorded.
Main Results:
- Most respiratory variables declined post-operatively, with gradual recovery. Maximal inspiratory pressure (MIP) returned to baseline by POD 5 in both groups.
- The CPAP group showed a significant improvement in peak expiratory flow (PEF) on POD 1 (p=0.04).
- No significant differences were observed in hospitalization or intensive care unit length of stay between groups.
Conclusions:
- Prophylactic NIV, specifically CPAP, is safe and well-tolerated in pediatric cardiac surgery patients.
- The utilized CPAP protocol effectively enhanced PEF on the first post-operative day.
Objective:
To evaluate the effectiveness of prophylactic, non-invasive ventilation (NIV) on respiratory function in seven- to 16-year-old children in the post-operative phase of cardiac surgery.
Method:
A randomized, controlled trial with 50 children who had undergone cardiac surgery with median sternotomy. After extubation, patients were randomly assigned to one of two groups: control group (n=26), which received instructions regarding posture, early ambulation, and cough stimulation, and CPAP group (continuous positive airway pressure; n=24), which received the same instructions as the control group and CPAP=10 cmH20 twice daily for 30 minutes from the 1st to the 5th post-operative day (POD). As a primary outcome, lung function was evaluated before and on the 1st, 3rd, and 5th PODs with measures of respiratory rate (RR), tidal volume (TV), slow vital capacity (SVC), inspiratory capacity (IC), minute volume (MV), peak expiratory flow (PEF), and maximal inspiratory pressure (MIP). As secondary outcomes, the time of hospitalization and intensive care were recorded. A mixed, linear regression model and z-test were used to analyze respiratory function, considering p<0.05.
Results:
All variables, except RR and MV, showed a significant drop on the 1st POD, with gradual recovery; however, only MIP had returned to pre-operative values on the 5th POD in both groups. The RR showed a significant increase on the 1st POD, with a gradual reduction but without returning to baseline. In the intergroup analysis, significant improvement (p=0.04) was observed only in PEF in the CPAP group on the 1st DPO. The length of hospitalization and intensive care showed no significant differences.
Conclusion:
NIV was safe and well accepted in this group of patients, and the protocol used was effective in improving PEF on the 1st DPO in the CPAP group.
