Noninvasive Ventilation After Coronary Artery Bypass Grafting in Subjects With Left-Ventricular Dysfunction.
Respir Care
; 63(7): 879-885, 2018 07.
Article
en En
| MEDLINE
| ID: mdl-29895702
ABSTRACT
BACKGROUND:
The use of noninvasive ventilation in patients with left-ventricular dysfunction may increase cardiac performance by decreasing inspiratory effort and left-ventricular afterload. The aim of the present study was to evaluate the acute effects of noninvasive ventilation on central-venous oxygen saturation (ScvÌO2 ) and blood lactate in subjects with left-ventricular dysfunction during the early postoperative phase of coronary artery bypass grafting.METHODS:
This study included 100 subjects during the postoperative phase of elective coronary artery bypass grafting. Blood samples, at 5 time points, were collected to assess tissue perfusion markers (ie, ScvÌO2 and blood lactate) as follows (1) the intraoperative period (after anesthesia induction); (2) 20 min after ICU arrival, under intermittent mandatory ventilation; (3) 20 min after extubation with spontaneous breathing; (4) after 1 h of noninvasive ventilation; and (5) 20 min after discontinuation of noninvasive ventilation.RESULTS:
A significant increase in the blood lactate and a drop in the ScvÌO2 were observed on arrival to the ICU compared with intraoperative values (P < .001). After extubation, during spontaneous breathing, the ScvÌO2 significantly decreased (P = .02), whereas the blood lactate increased, although not significantly (P = .21) compared with intermittent mandatory ventilation on arrival to the ICU. During the application of noninvasive ventilation, the ScvÌO2 significantly increased (P = .048) and the blood lactate significantly decreased (P = .008) compared with spontaneous breathing values after extubation. After noninvasive ventilation discontinuation, the ScvÌO2 and blood lactate did not change compared with measures taken during noninvasive ventilation; higher values of ScvÌO2 were maintained compared with those obtained after extubation (P < .001).CONCLUSIONS:
The acute application of noninvasive ventilation improved ScvÌO2 and decreased the blood lactate in subjects with left-ventricular dysfunction during the early postoperative phase after coronary artery bypass grafting. (ClinicalTrials.gov registration NCT02767687.).Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
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Puente de Arteria Coronaria
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Disfunción Ventricular Izquierda
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Ventilación no Invasiva
Tipo de estudio:
Etiology_studies
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Evaluation_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Año:
2018
Tipo del documento:
Article