[Noninvasive mask ventilation of the lungs in the treatment of acute respiratory insufficiency in heart surgery patients in the postoperative period]

Abstract

Noninvasive ventilation of the lungs using a mask (NIVLM) was used in 54 patients with hypercapnic (n = 14) and hypoxemic (n = 40) respiratory failure. Respironics (USA) nasal and facial masks were applied. Ventilation regimens were selected individually. Trigger monitored ventilation, intermittent forced ventilation of the lungs, and assisted ventilation with positive expiratory pressure, biphasic positive pressure in the airways, and constant positive pressure in the respiratory contour were used. The efficacy of NIVLM in patients with hypercapnic respiratory failure was 100%. The pCO2 and ETCO2 normalized in all patients both during and after discontinuation of NIVLM. Despite a relatively long period of ventilation (229 +/- 72 min), the patients did not complain of discomfort during the procedure; no complications or individual intolerance of nasal or facial masks were observed. In patients with hypoxemic respiratory failure NIVLM resulted in a decrease of dyspnea, increase of respiratory volume, etc. The detected changes did not disappear after NIVLM was discontinued. Individual tolerance of nasal and facial masks was somewhat worse in this group: patients complained of stuffiness, lack of air, difficult respiration. Six patients (18.2%) developed episodes of psychomotor excitation which required sedative and analgesic therapy. In general, the efficacy of NIVLM was 91%, but resolution of respiratory failure without repeated intubation of the trachea was attained in only 33 patients (87%) with the hypoxemic condition. The mean duration of NIVLM in this group was 464 +/- 47 min. Hence, NIVLM is an effective method for respiratory support in patients with both hypoxemic and hypercapnic respiratory failure, which helps decrease the duration of forced ventilation of the lungs or do without repeated intubation of the trachea.