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Respir Care. 2018 Jun 12. pii: respcare.05851. doi: 10.4187/respcare.05851. [Epub ahead of print]

Noninvasive Ventilation After Coronary Artery Bypass Grafting in Subjects With Left-Ventricular Dysfunction.

Author information

1
Cardiology and Cardiovascular Surgery Disciplines, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.
2
Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois.
3
Cardiology and Cardiovascular Surgery Disciplines, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil. s_guizilini@yahoo.com.br.
4
Department of Health Sciences, Physiotherapy School of Federal University of São Paulo, Santos, São Paulo, Brazil.

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 (Scv̄O2 ) 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, Scv̄O2 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 Scv̄O2 were observed on arrival to the ICU compared with intraoperative values (P < .001). After extubation, during spontaneous breathing, the Scv̄O2 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 Scv̄O2 significantly increased (P = .048) and the blood lactate significantly decreased (P = .008) compared with spontaneous breathing values after extubation. After noninvasive ventilation discontinuation, the Scv̄O2 and blood lactate did not change compared with measures taken during noninvasive ventilation; higher values of Scv̄O2 were maintained compared with those obtained after extubation (P < .001).

CONCLUSIONS:

The acute application of noninvasive ventilation improved Scv̄O2 and decreased the blood lactate in subjects with left-ventricular dysfunction during the early postoperative phase after coronary artery bypass grafting.

KEYWORDS:

arterial lactate; cardiac surgery; central-venous oxygen saturation; coronary artery bypass grafting; left-ventricular dysfunction; noninvasive ventilation; tissue perfusion

PMID:
29895702
DOI:
10.4187/respcare.05851

Conflict of interest statement

The authors have disclosed no conflicts of interest.

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