2017EFFECTIVENESS OF CONTINUOUS POSITIVE PRESSURE VENTILATION IN REDUCING THE LENGTH OF STAY IN POST CARDIAC BYPASS SURGERY PATIENTS
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Abstract
Objectives: To asses the length of stay using Continuous Positive pressure ventilation (CPAP) during weaning in post bypass patients in cardiac ICU and compared this procedure with MV (Mechanical ventilation) by analyzing cardiac and respiratory parameters and complications.
Material and Methods: A randomized clinical trial was conducted from June 2011 to July 2012 with patients in the cardiac ICU of Lady Reading Hospital Peshawar Pakistan. Patients of both sexes and ages between 45-70 years, post bypass surgeries and were on mechanical ventilation for more than 48 hours, who failed at 30 minutes of spontaneous breathing trial (SBT) were included in the study. Sealed envelopes were used for random assignment. The established weaning criteria was routinely followed in the ICU. Before SBT, the following measurements were carried out: arterial blood gases; parameters of ventilation such as f (frequency of breaths),VT (Tidal volume), PEEP (Positive end expiratory pressure), FiO2(Fraction of inspired oxygen), HR(Heart rate), systolic (SBP) diastolic (DBP) blood pressure and SpO2 (Oxygen saturation).SBT , 30 minutes was given,If failure occurred before the 30th minute ,he/she was included in the group previously defined by random assignment. Patients in the experimental group were extubated and placed on CPAP, whereas the other patients (the control group) returned to MV, which was classified as the conventional treatment.
Spontaneous ventilation mode using a bi-levelCPAP support was used in experimental group immediately after trachealextubation,. The interface chosen was facemask. Daily SBT was carried out thereafter in order to evaluate the possibility of extubation in control group.
Results: Eighty patients who failed T-piece trials ventilation, 40 were placed on CPAP and 40,on intermittent mandatory ventilation or mechanical ventilation (IMV). The ages of patients in the CPAP and IMV groups were 45.7± 18.12 and 47.10 ± 18.44 years respectively. In both groups, ventilation time before T-piece trial was 2 days or 48 hours. Heart and respiratory parameters were similar for the two groups at 30 minutes of T-piece trial. The percentage of minor complications
in both groups were lower. The comparisons of gas measurements between the CPAP and IMV groups showed no significant differences . Patients of the CPAP group had a shorter stay in the ICU and in the hospital i-e 2.95 ±0.78 days versus 7.44+1.12 days for IMV group (Table No 2). Mortality was similar in the two groups. Of the 80 patients in both groups no serious complications were seen on ventilator support while discharged from the ICU.
Conclusion: The combination of early extubation and CPAP is a good alternative for ventilation in a group of patients who initially failed weaning. The length of stay is significantly reduced in Cardiac ICU ,compared to Mechanical ventilation.
Therefore, CPAPis a useful and safe strategy that may be considered during mechanical ventilation weaning.
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