Non-invasive ventilation in cardiac surgery: a concise review

Abstract

Mild to severe respiratory dysfunction is still a common issue after cardiac surgery. Postoperative respiratory complications are associated with prolonged hospitalization and worse survival. In this high-risk surgery, non-invasive ventilation could have relevant positive effects. The present narrative concise review aims to summarize available data on the role of non-invasive ventilation before and after cardiac surgery. Non-invasive ventilation exerts its main effects on the pulmonary and on the cardiovascular systems. Non-invasive ventilation can be applied to prevent acute respiratory failure; it can also be prescribed as a curative tool to treat an established postoperative acute respiratory failure. Non-invasive ventilation could also be applied to wean patients from mechanical ventilation. When applied as a preventive tool, the main scope is the prevention of pneumonia by resolving or preventing atelectasis. So far, limited (but encouraging) data are available: its routine use in all patients to prevent postoperative acute respiratory failure cannot be recommended. Non-invasive ventilation to treat postoperative acute respiratory failure has been evaluated more extensively. A failure rate from 10 to 55% was reported. Safety appears preserved, with no relevant hemodynamic complication reported. Non-invasive ventilation has also been applied during percutaneous aortic valve implant in patients unable to lie supine due to severe respiratory limitation and orthopnea. In conclusion, non-invasive ventilation has the potential to be very useful before and after cardiac surgery. So far, results are promising but available data are limited. Training and experience are essential to obtain positive results and to avoid complications.

Keywords: acute respiratory failure; cardiac anesthesia; cardiac surgery; non invasive ventilation; perioperative medicine.