Author + information
- Yi Yang,
- Lizhong Sun,
- Yong Yang and
- Nan Liu
To assess the efficacy of prophylactic de-escalation use of noninvasive positive pressure ventilation (NPPV) in preventing hypoxemia following extubation after Stanford type A aortic dissection (AD), and the effect on re-intubation and hospitalization.
Since the patients of Stanford type A AD suffering from the highest incidence of hypoxemia post-cardiac surgery,40 patients were investigated who recovering from Stanford type A AD operation in the Center for Cardiac Intensive Care, Anzhen Hospital between December 1, 2015 and April 30, 2016, and meet the inclusion criterion after extubation. The patients were random divided into two groups(simple randomization with RandA1.0 software), each group contained 20 patients: traditional oxygen treatment with mask vs. NPPV with mask(age of years 54.6±8.9 vs. 53.8±9.7,p>0.05; male 60%vs. 65%,p>0.05; APACHE II 15.8±1.9 vs. 16.5±2.1,p>0.05). Oxygen treatment settings:flux of oxygen was 6-10L/min, and fraction of inspired oxygen (FiO2) was 35-55%. NPPV initial 2 hours settings: inspiratory pressure (IPAP) of 14-16 cmH2O, expiratory pressure (EPAP) of 6-8 cmH2O, FiO2 35-55%;2-8 h the parameters were decreased:IPAP 10-12cmH2O, EPAP 4cmH2O;after 8 h the NPPV was finished and the oxygen treatment instead. Make a comparison in the clinical effect at different times, and compare re-intubation,complication,mortality, intensive care unit(ICU) duration and hospitalization between two groups.
PaO2 and PaO2/FiO2 were higher in the prophylactic NPPV group after 2h(84.5(78.7,87.1) vs. 94.7(89.7,100.1), 167.0±18.9 vs. 192.7±31.2, both p<0.05), 8h(86.3(82.3,95.6) vs. 99.1(90.3,132.8), 172.5(164.7,191.2) vs. 198.2(180.5,246.2), both p<0.05), 24h(87.3±12.9 vs. 100.0±18.9, 170.1±29.8 vs. 197.5±36.8, both p<0.05) and 3 day (86.8(79.4,89.6) vs. 98.2(87.4,110.5), 164.4±23.8 vs. 193.2±37.1, both p<0.05), and respiratory rate was lower in the NPPV group at the same time. Heart rate and mean arterial pressure were lower in NPPV group at 24 h and 3d. At 3d in NPPV group PaCO2 was lower, and left ventricular ejection fraction was improved (53.5±6.4 vs. 58.5±4.7, p<0.05). Compared the two groups, there were no statistical difference in the re-intubation incidence(15%vs.5%, p>0.05), hospital mortality (10% vs.10%,p>0.05)and ICU time(h) (102.2±79.1 vs. 103.7±76.4, p>0.05). But the oxygen treatment leaded to a higher incidence of atelectasis (30% vs.5%, p<0.05), and longer hospitalization time(15.5(12.3,23.5) vs. 13.0(12.0,15.0), p<0.05). However, lower setting NPPV indicated no obvious differences in abdominal flatulence (5% vs. 25%,p>0.05), intolerance (0 vs.15%, p>0.05) and facial pressure ulcers (0 vs. 5%,p>0.05).
In the early stage after extubation, prophylactic de-escalation therapy of NPPV for patients post-operation of Stanford type A AD, may quickly improve oxygenation, decrease respiratory work, and increase the heart function, avoid atelectasis by the positive airway pressure. Furthermore, there was no statistical difference in the complications, and the hospital stay was shortened by NPPV.