|
Background: Noninvasive bilevel positive airway pressure (BiPAP) support ventilation applied by nasal mask in children with impending respiratory failure enhances oxygenation/ventilation, decreases the work of breathing, and may obviate the need for an artificial airway. This study was to provide a prospective evaluation of clinical experience in this special population, suggesting a wider role for this less intrusive ventilatory support modality.
Methods: Twenty-five patients (3 months to 11 years, mean 2.3 years) who underwent corrective cardiac surgery and developed respiratory insufficiency after extubation were enrolled in the study. All patients required airway support or oxygenation/ventilatory support and were firstly treated with noninvasive BiPAP ventilation before re-intubation. The changes of clinical symptoms and arterial blood gas were measured.
Results: The 25 patients with 30 episodes of respiratory insufficiency requiring airway support or oxygenation/ventilatory support were treated with BiPAP ventilation with a mean duration of 1.96 days (range, 0.03 to 12 days). No major complications were observed. Twenty-five episodes (83.3%) benefited from BiPAP and avoided re-intubation. One hour after institution of BiPAP, the patients showed an acute improvement of oxygenation. pH increased from 7.37¡À0.02 to 7.41¡À0.01, SaO2 increased from 93.8¡À1.0% to 97.7¡À0.4%, PaO2/FiO2 increased from 189.9¡À25.0 to 253.6¡À21.2 mmHg, and A-aDO2 decreased from 241.8¡À18.7 to 182.1¡À16.5 mmHg (all P<0.05). Four hours after BiPAP, PaCO2 significantly decreased from 44.0¡À2.1 to 38.9¡À0.8 mmHg (P<0.05). Meanwhile, heart rate decreased from 157¡À4 to 139¡À4 beats/minute, respiratory rate decreased from 46¡À2 to 37¡À2 breaths/minute, rate-pressure product decreased from 17 230¡À685 to 14 046¡À423 mmHg ¡¤ beats/minute (all P<0.05). Five episodes in 4 patients were unable to stabilize progression of respiratory failure and an artificial airway was subsequently placed. All patients survived with a mean mechanical ventilation duration of 3.4 days and an ICU stay of 10.6 days.
Conclusions: Noninvasive nasal mask BiPAP can be safely and effectively used in children after cardiac surgery to improve oxygenation/ventilation, decrease the work of breathing. It may be particularly useful in patients whose underlying condition warrants avoidance of re-intubation.
Key words: noninvasive positive pressure ventilation; respiratory failure; children; cardiac surgery
|
