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Postoperative Respiratory Support After Cardiac Surgery: The BREASE ARC International Survey
Axel Hirwe1, Nicolas Nesseler2, Gudrun Kunst3
1Sorbonne University, GRC 29 Clinical Research Group in Anesthesiology, Critical Care and Perioperative Medicine, ARPE, Paris, France; Department of Anesthesiology and Critical Care, AP-HP, Pitié Salpêtrière Hospital, DMU DREAM, Paris, France.
Summary
Postextubation noninvasive respiratory support after cardiac surgery varies widely among clinicians. Combined high-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) strategies are increasingly used, but standardized protocols are needed.
Area of Science:
- Critical Care Medicine
- Anesthesiology
- Cardiovascular Surgery
Background:
- Postextubation respiratory support is crucial for cardiac surgery patients.
- Current strategies exhibit significant variability across institutions.
Purpose of the Study:
- To describe current clinician-reported postextubation noninvasive respiratory strategies after cardiac surgery.
- To identify emerging combined strategies and variability in practice.
Main Methods:
- Cross-sectional survey of 92 clinicians from cardiac surgery units.
- Descriptive analysis of institutional protocols and individual practices.
Main Results:
- 40% of respondents reported institutional protocols for noninvasive respiratory support.
- 77% used prophylactic noninvasive support, primarily for high-risk patients (obesity, COPD, OSA).
- Combined high-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) is the most common prophylactic (37%) and treatment strategy (54%).
Conclusions:
- Postextubation respiratory practices after cardiac surgery are highly variable.
- Increasing adoption of combined HFNO-NIV strategies observed.
- Need for harmonized protocols and multicenter trials to optimize respiratory support.
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